老年自发性SAH首次脑血管造影阴性原因分析及对策

Negative Cause Analysis and Treatment Strategy of Cerebral Angiography in Patients with Senile Subarachnoid Hemorrhage

目的探讨影响老年自发性蛛网膜下腔出血(subarachnoid hemorrhage,SAH)首次数字减影血管造影(digital subtraction angiography,DSA)阴性的相关因素,以采取相应的对策降低检查阴性率。方法回顾性分析2009年1月—2015年1月由外院转入的院外首次DSA阴性的28例老年自发性SAH临床资料,分析造成首次DSA阴性的相关因素。结果单因素分析结果显示,高血压病史、Hunt-Hess分级、动脉瘤内血栓形成、脑血管痉挛、动脉瘤直径、隐匿性血管畸形、海绵状血管瘤、中脑周围非动脉瘤性蛛网膜下腔出血(PNSH)、DSA仪器、医师年资、造影照射角度为老年自发性SAH首次DSA阴性的影响因素。logistic回归分析结果显示,Hunt-Hess分级Ⅰ级、动脉瘤内血栓形成、脑血管痉挛、动脉瘤直径<3 mm、隐匿性血管畸形、海绵状血管瘤、PNSH、二维DSA仪器、医师年资<5年、造影照射角度不当为老年自发性SAH首次DSA阴性的独立影响因素。结论导致老年自发性SAH患者首次DSA阴性有多种因素,临床医师和影像科医师应根据相关因素积极采取相应的处理对策,并注意及时复查,以免延误病情。

Objective To explore the related factors of the negative effect of the first cerebral angiography in the elderly patients with subarachnoid hemorrhage, and to take appropriate measures to reduce the negative rate.Methods A retrospective analysis of subarachnoid hemorrhage from January 2009-2015 year, who have completed the first DSA detection in other hospital and transformed into our hospital.The clinical data were collected, to analyze the influencing factors of the first negative cerebral angiography of senile subarachnoid hemorrhage in 28 cases.Results By single factor analysis, history of hypertension, Hunt-Hess grading, intra aneurysmal thrombus formation, vascular conditions, aneurysm diameter, occult vascular malformation, cavernous hemangioma, PNSH, two-dimensional DSA instrument, physician seniority, contrast the irradiation angle for elderly SAH first DSA examination related factors of yin.Logistic regression analysis, Hunt-Hess classification grade, aneurysm thrombosis, vascular spasm, aneurysm diameter less than 3 mm, occult vascular malformation, cavernous hemangioma, PNSH, two-dimensional DSA instrument doctor, seniority for less than 5 years, angiography, improper irradiation angle is independent factors.Conclusion The effect of the first negative cerebral angiography in senile subarachnoid hemorrhage has many related factors, which should be reexamination without delay, in order not to delay the treatment.