后交通动脉瘤破裂患者临床特征及继发脑血管痉挛情况分析

Clinical Features of Posterior Communicating Artery Aneurysm Rupture and Secondary Cerebral Vasospasm

目的探讨后交通动脉瘤破裂患者临床特征及继发脑血管痉挛情况。方法回顾性分析2003年8月—2013年1月河北医科大学第一医院神经外科收治的96例后交通动脉瘤破裂患者的临床资料,采用Hunt-Hess分级进行临床分级,Fisher分级对患者入院时蛛网膜下腔出血量进行分级,脑血管造影(DSA)评价患者血管狭窄程度。结果 (1)Hunt-Hess分级:Ⅰ级16例,Ⅱ级36例,Ⅲ级27例,Ⅳ级14例,Ⅴ级3例。Hunt-Hess分级中Ⅰ～Ⅱ级、Ⅲ级、Ⅳ～Ⅴ级患者脑血管痉挛发生率比较,差异有统计学意义(P<0.05),且Ⅳ～Ⅴ级患者脑血管痉挛发生率高于Ⅲ级和Ⅰ～Ⅱ级患者(χ2值分别为4.14和12.51,P<0.05)。(2)Fisher分级:1级16例,2级36例,3级27例,4级17例。Fisher分级3～4级患者脑血管痉挛发生率高于1～2级患者(χ2=10.27,P<0.01)。(3)DSA检查结果:左侧后交通动脉瘤51例,右侧后交通动脉瘤45例;单发后交通动脉瘤86例,多发后交通动脉瘤10例;动脉瘤直径<5 mm者23例,5～15 mm者51例,16～25 mm者20例,>25 mm者2例;无狭窄者56例,轻中度狭窄者31例,重度狭窄者9例,不同血管狭窄程度患者脑血管痉挛发生率比较,差异有统计学意义(P<0.05),且重度狭窄患者脑血管痉挛发生率高于轻中度狭窄和无狭窄患者(χ2值分别为19.98和21.80,P<0.05)。结论 Hunt-Hess分级越高、Fisher分级越高、DSA显示血管狭窄程度越重的后交通动脉瘤破裂患者脑血管痉挛发生率越高。

Objective To investigate the clinical features of posterior communicating artery aneurysm rupture （PCAAR） and secondary cerebral vasospasm （CV）. Methods Clinical data of 96 PCAAR patients admitted to this hospital from August 2003 to January 2013 were graded clinically by Hunt - Hess grade, subarachnoid hemorrhage on admission graded by Fisher grade, vascular stenosis evaluated by digital subtraction angiography （ DSA ）. Results In Hunt - Hess grade, 16 had grade Ⅰ , 36 grade Ⅱ , 27 grade m, 14 grade IV, 3 grade V, there was significant difference in CV incidence in patients with grades Ⅰ- Ⅱ, Ⅲ, Ⅳ-Ⅴ （P〈0.05）, and higher in patients with grades Ⅳ-Ⅴ than in those with grades Ⅲ, Ⅰ- Ⅱ （X2 =4. 14, 12.51, P〈0.05）. In Fisher grade, 16 had grade 1, 36 grade 2, 27 grade 3, 17 grade 4; CV incidence was higher in patients with grades 3 -4 than in those with grades 1 -2 （X2 =10.27, P〈0.01）. In DSA results, 51 had left PCAA, 45 had right; 86 had single PCAA, 10 had multiple; 23 had 〈5 mm PCAA, 51 had 5 - 15 mm, 20 had 16 -25 ram, 2 had 〉25 ram; 56 had no stenosis, 31 had mild or moderate stenosis, 9 had severe; There was significant difference in CV in- cidence in patients with different degrees of stenosis （ P 〈 0. 05 ） , and higher in patients with severe stenosis than in those with mild or moderate, or without stenosis （ X2 = 19.98, 21.80, P 〈 0. 05）. Conclusion PCAAR patients with high Hunt - Hess grade, Fisher grade, severe vascular stenosis have high CV incidence.