颅内动脉瘤破裂术后脑积水60例临床分析

Clinical analysis of post-operative hydrocephalus from 60 cased of ruptured intracranial aneurysms

目的分析颅内动脉瘤破裂蛛网膜下腔出血术后脑积水的高危因素、诊疗方法及预后。方法回顾性分析2016年1月至2017年12月本科收治的60例颅内动脉瘤破裂术后发生脑积水患者的临床资料。结果 60例SAH术后脑积水患者中,60岁以上患者占76.7%,大脑后动脉动脉瘤和后交通动脉瘤占78.3%,Hunt-Hess分级III-IV级患者占80%,SAH发生2次患者脑积水发生率为68.3%,高血压患者占80%,手术后,恢复良好者45例,轻度残疾者8例,重度残疾者3例,植物死亡者2例,死亡者2例。结论蛛网膜下腔出血术后并发脑积水常见的危险因素包括高龄、大脑后动脉动脉瘤、后交通动脉瘤、Hunt-Hess高分级、多次发生SAH、高血压病史,CT在诊断SAH后脑积水中应用价值较高,手术治疗能够取得良好的疗效,改善患者的预后。

Objective To analyze the risk factors, diagnosis and ＂creammnt and prognosis of hydrocephalus after operation for subarachnoid hemorrhage caused by ruptured intracranial aneurysms. Methods The clinical data of the 60 patients with hydrocephalus after operation for ruptured in- tracranial aneurysms were analyzed retrospectively. Results Of all the patients, 60 years old and older patients accounted for 76.7 %, patients with aneurysms located posterior cerebral artery and posterior communicating artery accounted for 78.3 %, patients with II%IV Hunt Hess grade accounted 80%, patients who experienced subarachnoid hemorrhage twice accounted for 68.3%, patients with hypertension accounted for 80%. After the operation of shunt, the outcome was considered as good in 45 cases, fair in 8 cases, and poor in 3cases, 2 patients were vegetables and 2 patientswere dead. Conclusion The most common risk factors of hydrocephalus after operation for subarachnoid hemorrhage caused by ruptured intracranial aneurysms were older patients, aneurysms located posterior cerebral artery and posterior communicating artery, high grade of Hurt- Hess, high frequency of subarachnoid hemorrhage, history of hypertension. CT is an effective and accurate method in the diagnosis of hydrocephalus. The operation of shunt can improve the prognosis of patients.