出血型烟雾病急诊救治方法的选择

Selecting diagnosis and clinical therapy means in acute phase of hematogenous moyamoya

目的探讨出血型烟雾病的临床特征与急诊救治方法。方法回顾性分析急诊入院的52例出血型烟雾病患者的临床特征、血管影像结果、治疗方法的选择及转归。结果 52例出血型烟雾病患者的平均发病年龄(37.51±11.48)岁,首发症状以头痛(28例,53.8%)和意识障碍(20例,38.5%)为主。出血多累及脑室系统,血管造影(DSA、CTA)发现单侧或双侧颈内动脉远端闭塞,伴异常毛细血管网形成。内科治疗32例,其中6例保守治疗后择期血管重建,外科血肿引流18例,2例确诊后拒绝治疗。结论关注青壮年脑出血患者,急诊脑血管造影是诊断出血型烟雾病的主要手段;选择正确的治疗方法是急诊救治的重要环节。

Objective To investigate the clinical features of hemorrhagic moyamoya disease and se- lect exact diagnosis and treatment means in emergency. Methods The clinical features, cerebrovascular angiography results, the choice of treatment and outcome in 52 cases of hemorrhagic moyamoya disease were analyzed retrospectively. Results Patients with moyamoya disease have high risk of cerebral haem- orrhage in young adults, the average age was 37.51±11.48. The main initial symptoms were headache （28,53.8%） and disturbance of conseiousnes （ 20,38.5 % ） respectively. According to the outcome of CT scanning, periventricular hemorrhage accounted for the most. Cerebrovascular angiography （digital subtration angiography, DSA; muhislice CT angiography, CTA） found bilateral or unilateral carotid artery stenosis as well as the moyamoya vessels at the base of the brain. Thirty-two patients received conservative management, 6 patients of these underwent neurosurgical revascularization procedures, 18 patients received surgical hematoma drainage , 2 patients refusing treatment after diagnosis. Conclusion Atten- tion should be paid to young patients with intracerebral hemorrhage. Cerebrovascular imaging is the prima- ry means for diagnosis of hemorrhagic moyamoya disease. Exact conservative or surgical means is important in the emergency treatment.