破裂动脉瘤术后症状性脑血管痉挛46例临床分析

Clinical analysis of postoperative symptomatic cerebral vasospasm following intracranial aneurysm rupture

目的探讨破裂动脉瘤术后发生症状性脑血管痉挛(SCVS)的影像学特征与预后情况。方法收集近年来破裂动脉瘤术后发生症状性脑血管痉挛患者资料46例,回顾性分析临床资料,其中的影像学检查资料与预后情况。预后情况根据格拉斯哥预后评分标准评定。结果经颅多普勒(TCD)检查对动脉瘤术后发生症状性脑血管痉挛的阳性发现率可达100%(46/46)、三维CT血管成像阳性发现率亦100%(39/39)。依据格拉斯哥预后评分(GCS)标准:46例患者中死亡7(15.2%)例,植物状态4(8.7%)例,重残5(10.8%)例,中残12(26%)例,恢复良好18(39.1%)例。结论大部分症状性脑血管痉挛患者在经颅多普勒(TCD)、三维CT血管成像等检查上会有阳性发现;术后发生的SCVS将是预后不良的一种指示。

Objective To evaluate the image feature and outcome of symptomatic cerebral vasospasm（SCVS） following aneurysm surgery. Methods The clinical data of 46 cases with SCVS following aneurysm surgery were collected and the image data and their outcomes were analyzed with the Glasgow Outcome Scale （GOS）. Results Transcranial Doppler （TCD） and and three-dimensional CT angiography （3D-CTA）could detect 100% （46/46,39/39） of the SCVS patients. According to the GOS,39.1%（18/46） were classified as well recovered, 26%（12/46） as moderate disability, 10.8%（5/46） as severe disability, 8.7% （4/46）as vegetative state, and 15.2% （7/46） died. Conclusion Most of the patients with postoperative SCVS can be detected by TCD and 3D-CTA. Postoperative SCVS is an indicator of poor prognosis usually.