动脉瘤性蛛网膜下隙出血后脑血管痉挛的治疗及临床分析

Treatment and clinical analysis of cerebral vasospasm after aneurysmai subarachnoid hemorrhage

目的总结动脉瘤性蛛网膜下隙出血（SAH）后脑血管痉挛的防治经验及体会。方法选择住院治疗的58例颅内动脉瘤性SAH患者作为研究对象，对其临床资料进行回顾性分析。所有患者均行可脱性弹簧圈栓塞术血管内栓塞治疗颅内动脉瘤，术后采取腰大池持续引流、尼莫地平经深静脉持续泵人以及升高血压、增加血容量、稀释血液（3H）治疗等综合措施。结果58例患者中术后有8例患者发生脑血管痉挛，发生率为13．8％（8／58），主要表现为短暂性偏瘫4例，意识障碍加深2例，短暂性失语2例，经积极治疗，运动功能、意识障碍及语言功能均完全恢复，无植物生存和死亡病例。结论尽早行动脉瘤可脱性弹簧圈栓塞术，术后予脑脊液引流、尼莫地平静脉泵入、3H治疗等是治疗和预防动脉瘤性SAH后脑血管痉挛的有效方法。

Objective To summarize the experience of prevention and treatment of cerebral vasospasm after aneurysmal subaraehnoid hemorrhage （SAH）. Methods Fifty-eight eases with aneurysmal SAH were taken as study objects and their clinical data were retrospectively analyzed. All the patients with intracranial aneurysm undergoing Guglielmi detachable coils （GDC） or mechanical detachable coils（MDC） embolization were treated comprehensively by papaverine solution lavage in surgical field during intracranial aneurysm surgery,lumbar continued drainage of cerebrospinal fluid, nimodipine infusion continuously and blood pressure increasing,blood volume improving,blood diluting （3H） therapy after operation. Results Among the total 58 cases of SAH, 8 patients occurred cerebral vasospasm （ 13.8% ）, mainly included 4 eases of transient paralysis,2 cases of unconsciousness deepened,2 cases of transient aphasia,after active treatment, the motor function, disturbance of consciousness and language functions all restored with none in plant state or died. Conclusion Detachable coil embolization underwent in earlier period and then drained cerebrospinal fluid, infusioned nimedipine, taken 3H therapy and so on axe the effective measures for preventing and treating cerebral vasospasm after SAH.