自发性蛛网膜下腔出血全脑血管造影分析

Analysis of digital subtraction angiography in the patients with spontaneous subarachnoid hemorrhage

目的探讨数字减影全脑血管造影(digital subtraction angiography,DSA)对蛛网膜下腔出血(subarachnoidhemorrhage,SAH)病因诊断的价值。方法选择行DSA检查的SAH患者276例,根据发病时间分为<24 h组(A组)32例,1～3 d组(B组)111例,4～14 d组(C组)93例,>14 d组(D组)40例。又按年龄分为≤60岁患者248例,>60岁患者28例。对其病因、造影时间、并发症等进行分析比较。结果 276例SAH患者DSA病因诊断阳性率为71.4%。所有患者动脉瘤为主要病因,而动静脉畸形、烟雾病在年龄≤60岁患者中则更为常见。B组、C组、D组不同时间DSA的异常检出率明显高于A组,差异有统计学意义(P<0.05)。A组再出血、脑积水、消化道出血、低钠血症、癫痢发作的发生率高于其他组。结论 DSA对SAH病因诊断阳性率高,SAH患者病因诊断应常规行DSA检查,时间以发病1～3 d为宜。

Objective To explore the value of digital subtraction angiography（DSA）in etiological diagnosis of subarachnoid hemorrhage（SAH）. Methods Retrospective analysis was made in 276 patients with SAH examined by DSA. The patients were divided into four groups according to nosopoietic time. The patients with nosopoietic time 〈24 h were in group A,those with nosopoietic time of 1--3 d were in group B,4--14 d were in group C and 〉14 d were in group D. Group A had 32 patients,group B 111 patients,group C 93 patients and group D 40 patients. According to age, the patients were divided into two groups：group of 248 patients aged 460 years and group of 28 patients aged 〉60 years. The cause of disease,time of angiographic examination and complication were compared and analysed. Results The positive rate of DSA in etiological diagnosis of 276 patients with SAH was 71.4%. Aneurysm was the major cause of disease in all patients while arteriovenous malformation and smog disease were more common in the younger patients. The predilection sites of aneurysm were internal carotid artery and its bifurcation site,vertebrobasilar artery, posterior cerebral artery, anterior cerebral artery and anterior communicating artery. Groups B, C and D had higher positive rates than group A by comparing the abnormal detectable results of DSA in different periods,with statistical significance（P〈0.05）. The incidences of rehemorrhage, hydrocephalus, hemorrhage of digestive tract, hyponatremia, and epileptic attacks in group A were higher than those in the other groups. Conclusions The positive rate of DSA is high in etiological diagnosis. The patients with SAH should be regularly examined by DSA in etiological diagnosis. The appropriate time of examination is one to three days after onset of disease.