动脉瘤性蛛网膜下腔出血后再出血分析

Analysis of rebleeding after aneurysmal subarachnoid hemorrhage

目的评估动脉瘤性蛛网膜下腔出血(aSAH)后再出血的临床特征及危险因素,为aSAH再出血的预防提供指导。方法对12例再出血患者的临床特征、影像学资料、治疗及预后进行分析。结果12例再出血患者首发症状表现为头痛10例(83%),意识障碍8例(67%);入院时Hunt-Hess评分Ⅲ~Ⅳ级8例(67%),改良FisherⅢ~Ⅳ级10例(83%)。在SAH后的最初24小时内发生再出血7例(58%)。入院后再出血时平均动脉压显著增加。再出血患者责任动脉瘤位于大脑前动脉(ACA)及前交通动脉(AComA)4例(33%),多发动脉瘤5例(42%),所有患者均对动脉瘤进行处理。SAH后并发急性脑积水9例(75%),行脑室外引流6例(50%),减压颅骨切除术1例(8%),最终死亡5例(42%)。结论SAH后院内再出血死亡率高、预后差,积极干预危险因素,从而减少残疾率及病死率。

Objective To evaluate the clinical characteristics and risk factors of rebleeding after aneurysmal subarachnoid hemorrhage(aSAH),and provide guidances for the prevention of aSAH rebleeding.Methods The clinical characteristics,imaging data,treatment and prognosis of 12 patients with rebleeding were analyzed.Results The first symptoms of 12 patients with rebleeding were headache in 10 cases(83%),disturbance of consciousness in 8 cases(67%),with hunt Hess gradeⅢ-Ⅳin 8 cases(67%)and improved Fisher gradeⅢ-Ⅳin 10 cases(83%)on admission.A total of 7 patients(58%)had rebleeding within the first 24 hours after SAH.The mean arterial pressure after admission dramatically increased at rebleeding.The responsible aneurysms were located in the anterior cerebral artery(ACA)and anterior communicating artery(AComA)in 4 cases(33%),and there were 5 patients(42%)of multiple aneurysms.All patients received aneurysms treatment.After SAH,acute hydrocephalus occurred in 9 cases(75%),outdoor drainage in 6 cases(50%),decompressive craniectomy in 1 case(8%),and death in 5 cases(42%).Conclusion Re-bleeding after SAH has high mortality and poor prognosis.In order to reduce the disability and mortality rate,intervention in the risk factors should be actively done.