非动脉瘤性与动脉瘤性蛛网膜下腔出血的比较

Comparison between non-aneurismal and aneurismal subarachnoid hemorrhage

目的探讨非动脉瘤性蛛网膜下腔出血与动脉瘤性蛛网膜下腔出血的不同临床特点与预后。方法回顾性研究2005-2009年158例蛛网膜下腔出血患者的临床与影像学资料，评估患者入院时的Hunt—Hess分级、首次CT分型、并发症及出院时MRS评分的情况，并对经DSA检查明确为动脉瘤性蛛网膜下腔出血患者的动脉瘤直径、部位进行分析，对多发动脉瘤的性别、年龄进行分析。结果①两组患者入院时的Hunt—Hess分级比较差异有统计学意义,χ^2=12．8941，P=0．005；②两组cT分型比较差异有统计学意义，χ^2=61．2628，P=0．000；③动脉瘤性蛛网膜下腔出血组动脉瘤好发部位顺位为前交通动脉、大脑中动脉和后交通动脉，破裂动脉瘤以中小型动脉瘤多见，多发动脉瘤好发于中老年女性；④2组患者并发症主要出现在CT分型2～4型中，2组患者出院时MRS评分比较差异有统计学意义,χ^2=8．7776，P=0．003。结论非aSAH组患者具有以下特点：临床表现相对较轻，经治疗后颅高压及意识障碍的持续时间短，再出血、脑积水、脑梗死等并发症较少，死亡率较低，预后相对好。早期鉴别SAH是动脉瘤性还是非动脉瘤性临床较为困难。SAH患者有条件者应尽早DSA检查明确病因，对入院时CT分型≥2型的首次DSA阴性的患者应及时复查DSA排外“隐形”动脉瘤。

Objective To compare the clinical features and prognosis between non-aneurismal and aneurismal subarachnoid hemorrhage （SAIl）. Methods The clinical data and image findings of 158 patients with SAH admitted between 2005 and 2009 were retrospectively analyzed. Hunt-Hess grade on admission, initial CT classification, complications and modified Rankin scale （MRS） on discharge were assessed. The diameter and location of aneurysm were examined by digital subtraction angiography （DSA） in patients with aneurismal SAH. Results There were significant differences in Hunt-Hess grade on admission （χ^2= 12. 894 1, P = 0. 005 ）, CT classification （χ^2= 61. 262 8, P = 0. 000 ） and MRS scores on discharge （χ^2 = 8. 777 6, P = 0. 003 ） between patients with non-aneurismal and aneurismal SAH. The most common sites of aneurysm in patients with aneurismal SAH were the anterior communicating artery, the middle cerebral artery and the posterior communicating artery. Rupture was likely to be observed in small and medium-sized aneurysms. Multiple aneurysms often occurred among middle-aged and elderly women. Complications mostly happened in patients with a CT classification ranked 2 -4. Compared to patients with aneurismal SAH, those with non-aneurismal SAH were characterized with relatively mild clinical manifestations, shorter duration of increased intracranial pressure and consciousness disturbance, fewer complications such as recurrent bleeding, hydrocephalus and cerebral infarction, lower mortality and more favorable prognosis. Conclusion There are differences in clinical features and prognosis between non-aneurismal and aneurismal SAH; however, it is difficult to early differentiation between two conditions. DSA should be performed as early as possible for patients with SAH; for DSA-negative patients with CT classification ≥ 2 on admission, DSA should be repeated timely to exclude＂ occult＂ aneurysm.