重型动脉瘤性蛛网膜下腔出血的诊断与治疗

Diagnosis and treatment or tbe serious aneurysmal subarachnoid hemorrhage

目的探讨重型蛛网膜下腔出血(SAH)的有效诊断和治疗方法。方法回顾性总结分析了18例Hunt ＆ Hess分级Ⅲ级以上的重型动脉瘤性蛛网膜下腔出血病人的诊断和治疗。结果 16例痊愈,1例因血管痉挛继发广泛脑梗塞而植物生存,1例Ⅴ级病人于发病24小时内再发出血死亡。结论对重型动脉瘤性SAH要早诊断、早治疗;可采用DSA、MRA、CTA等多种手段进行诊断,同时要尽早实施有效的病因学治疗;手术或血管内治疗;血管痉挛的防治同样重要,以采用多种措施的综合治疗为宜,其中腰大池持续引流不失为一种有效的防治措施。

Objective To discuss the effective diagnosis and treatment of the serious aneurysmal subarachnoid hemor-rhage (SAH) . Methods Retrospectively summarized and analyzed the diagnosis and treatment of 18 cases with the seriors aneurysmal SAH (Hunt & Hess grade > Ⅲ ). Results 16 cases were cured. 1 case got vegetable survival caused by the general serious cerebral infarrtion atter cerebrovascular spasm . 1 case with Hunt & Hess grade V died of rebleeding within 24 hours after stroking. Conclusions It is necessary for serious aneurysmal SAH, to detect the cause and take the effective treatment early. DSA, MRA and CTA are effective approaches for diagnosis. The effective etiological treatment: operation or endovascular therapy, should be applied as soon as possible. Prevention and cure cerebrovascular spasm is equivalent im-portant. To take multiple measures against the spasm is better, in which the continuate lumbar cistern drainage must be an effective approach.