动脉瘤性蛛网膜下腔出血致Terson综合征的发生率及其相关因素分析

Incidence and relative factors of Terson syndrome in patients with aneurysmal subarachnoid hemorrhage

目的探讨颅内动脉瘤性蛛网膜下腔出血（SAH）所致Terson综合征的发生率及其相关危险因素。方法临床病例系列研究。对2009年11月至2010年5月确诊的101例（202只眼）SAH患者进行连续临床观察。所有患者在首次检查时均行直接检眼镜检查，诊断为Terson综合征的患者待其病情稳定后行双眼散瞳检查并拍摄眼底彩色照片。患者性别、年龄、意识状态、格拉斯哥昏迷评分（GCS）、Hunt-Hess分级和动脉瘤位置等与Terson综合征发生的相关因素分析采用χ2检验。结果101例动脉瘤性SAH患者中，发生Terson综合征者15例（14．8％），其中女性10例（10／58，17．2％），男性5例（5／43，11．6％），性别间Terson综合征发生率差异无统计学意义（χ2=0．615，P〉0．05）。意识障碍组患者31例，有12例（38．7％）发生Terson综合征，其发生率明显高于神志清醒组（3／70，4．3％），差异有统计学意义（χ2=17．503，P〈0．05）。GCS评分〈8者Terson综合征发生率（6／14，42．8％）明显高于GCS评分I〉8者（9／87，10．3％），差异有统计学意义（χ2=7．673，P〈0．05）。Hunt—Hess分级〉Ⅲ级者Terson综合征发生率（7／16，43．8％）明显高于≤Ⅲ级者（8／85，9．4％），差异有统计学意义（χ2=9．987，P〈0．05）。由此表明意识障碍、GCS评分较低及Hunt—Hess分级较高的患者Terson综合征发生率较高；但与动脉瘤的发生位置无相关性（χ2=0．000，P〉0．05）。随访期间发现有1例患者需行玻璃体切除术治疗。结论动脉瘤性SAH患者Terson综合征的发生率较高，与患者的全身情况明显相关。对意识障碍、GCS评分较低和Hunt—Hess分级较高的患者应重视眼部常规检查。多数Terson综合征患者的眼内出血可自行吸收，仅少数患者需手术治疗。

Objective To investigate the incidence and relative factors of Terson syndrome in patients with aneurysmal subarachnoid hemorrhage（SAH）. Methods A prospective case series study was conducted in 202 eyes of 101 patients with aneurysmal subarachnoid hemorrhage from November 2009 to May 2010. Fundus examination and color fundus photograph under mydriasis were carried out on every patient diagnosed as Terson syndrome with initial direct ophthalmoscopy after their general state was stable. The incidence of Terson syndrome was analyzed and correlated with gender, consciousness state, Glasgow Coma Scale score （GCS） and Hunt-Hess grade, anatomical locations of the ruptured aneurysms, mortality rate. Results Fifteen （14. 8% ） Terson syndrome patients were diagnosed in a total of 101 aneurysmal subarachnoid hemorrhage patients. Analysis of our data revealed no statistically significant difference between men and women in regard to the incidence of Terson syndrome （χ2 = 0. 615, P 〉 0. 05 ）. A significant relationship was observed between consciousness state （χ2= 17. 503, P 〈 0. 05 ）, GCS score （χ2 = 7. 673, P 〈 0. 05）, Hunt-Hess grade （χ2 = 9. 987, P 〈 0.05 ） and the incidence of Terson syndrome. A higher frequency of Terson syndrome was demonstrated in patients with consciousness disturbance, lower GCS score and higher Hunt-Hess grade. However, no correlation was found between localization of the ruptured aneurysm（χ2= 0. 000,P 〉 0. 05）, mortality rateand the occurrence of Terson syndrome. One case required surgical treatment during follow-up. Conclusions A higher frequency of Terson syndrome was observed in patients with aneurysmal subarachnoid hemorrhage, which had association with clinical conditions significantly. Therefore, the SAH patients with consciousness disturbance, lower GCS score and higher Hunt-Hess grade should be paid attention to ophthalmic conditions and performed fundus examination. The occurrence of Terson syndrome needs to be further explored whether to determine the prognosis in SAH patients. Terson hemorrhage absorbed spontaneously in most patients and required surgical intervention in very few patients.