老年人蛛网膜下腔出血诊疗方法的探讨

Evaluation on Diagnostic and Therapeutic Method in Elderly Patient with Sponaneous Subarachnoid Hemorrhage

目的 探讨老年人自发性蛛网膜下腔出血的诊断和治疗。方法 选择本院1993年6月至1999年6月收治的60岁以上老年人自发性蛛网膜下腔出血共64例,男26例,女38例,均行头颅CT证实蛛网膜下腔出血(不合并颅内血肿);腰穿呈血性脑脊液。40例行DSA检查,动脉瘤31例、动静脉畸形5例、Moyamoya病1例、动脉硬化3例。内科保守治疗29例,血管内治疗25例,手术夹闭及切除病灶10例。结果 内科保守治疗组死亡8例(8/29),血管内治疗死亡2例(2/25),手术夹闭及切除病灶组死亡1例(1/10)。结论 老年人自发性蛛网膜下腔出血以动脉瘤破裂常见,DSA是其病因诊断最有价值的手段;动脉瘤破裂至自发性蛛网膜下出血以血管内治疗及手术为有效的治疗方法。

Objective In this paper, the authors summarized the therapeutic outcomes of differentt methods in the management of spontaneous subarachnoidal hemorrhage (SAH) in the elderly patients. Methods From 1993 to 1999, 64 cases with SAH were admitted (male 26, Female 38). The diagnosis of these patients were mainly established on CT findings. Among them, 40 cases received the DSA which confirmed that SAHs were attributable to the aneurysm in 31 cases, AVMs in 5. Moyamoya's disease in 1 and arterial sclerosis in another 3 patients. Conservative treatment was adopted in 29 of these 64. endovasecular embolization in 25, and surgical clipping and/or radical resection in another 10 patients. Results Eight patients died in the conservative group (8/29), 2 in the embolization group (2/25), and 1 in the clipping and operative group (1/10). Conclusion Aneurysm was usually the cause of spontaneous SAH in elderly patients. The authors concluded that, in dealing with spontaneous SAH in elderly patients, ednovasculization or surgical intervention was the most effective therapeutic method .