51例蛛网膜下腔出血临床特征分析

Analysis of clinical characteristic of 51 cases of patients with subarachnoid hemorrhage

目的对蛛网膜下腔出血的临床特征进行分析,增强对该病的认识,提高诊断率。方法对我科2007-09~2009-09收住的51例蛛网膜下腔出血患者的人群特征、发病诱因、首发症状及体征、辅助检查、误诊、主要并发症、治疗及预后等方面进行分析讨论。结果女性多于男性,平均年龄54岁;活动为主要诱因,严重头痛为主要症状,绝大多数脑膜刺激征阳性,CT为首选检查手段,CT检查阴性者可选择腰椎穿刺;动脉瘤为主要原因,易误诊为感冒、高血压、脑供血不足等;再出血、脑血管痉挛、脑积水为主要并发症,脑脊液置换可以较快减轻头痛症状,大多预后良好,无明显后遗症;高龄、严重并发症者、Hunt和Hess分级高者、伴血小板减少等血液系统疾病者预后差,病死率高。结论若能认识蛛网膜下腔出血,容易作出正确诊断,使患者有良好预后。

Objective To enhance the understanding of the disease and improve diagnosis rate through analyzing clinical characteristic of patients with subarachnoid hemorrhage.Methods Fifty-one patients with SAH who were admitted to our department were enrolled.Such factors about demography,precipitating cause,symptom and sign at onset,investigation,misdiagnosis,complication,treatment and prognosis were analyzed.Results Female outnumber male.Activity is major precipitating cause.Severe headache is main symptom.Meningeal irritation is obvious in most patients.CT is preferred investigation.Lumbar puncture may be chose if there is no positive finding on CT.Aneurism is major cause.SAH may be misdiagnosed as cold,hypertension,cerebral circulation insufficiency etc.Re-bleeding,vasospasm,hydrocephalus are main complications.Headache could be alleviated faster by cerebrospinal fluid replacement than single medical treatment.The prognosis is good in most patients with no obvious sequela.The death rate is higher in patients with advanced age,severe complications,high Hunt Hess grade,haematological diseases such as thrombocytopenia.Conclusion SAH can be diagnosed right if its main clinical feature be acquainted very well.Patients usually have better prognosis.