大脑中动脉瘤破裂合并侧裂内血肿与脑内血肿临床分析

Clinical features of ruptured middle cerebral artery aneurysm combined with interhemispheric subdural hematoma and intracerebral hematoma

目的研究大脑中动脉(MCA)动脉瘤破裂合并侧裂内血肿与脑内血肿的临床特点、预后及影像学特点。方法回顾性选取2014年12月至2019年12月在西安医学院附属宝鸡医院接受治疗的MCA主干分叉部动脉瘤破裂导致蛛网膜下腔出血(SAH)且伴有侧裂内血肿(ISH)或脑实质内血肿(ICH)患者30例,其中ICH组17例,ISH组13例。比较两组患者入院时的性别、年龄、高血压病史、收缩压、血肿体积、动脉瘤侧别、动脉瘤大小、MCA主干与动脉瘤起点和破裂口连线形成的α角,并采用世界神经外科联盟(WFNS)分级量表及格拉斯哥昏迷指数(GCS)评价两组患者出院后的预后。结果两组患者的血肿侧别、动脉瘤大小比较差异均无统计学意义(P>0.05);ICH组患者的血肿体积为(33.3±17.6)mL,明显大于ISH组的(11.5±1.5)mL,差异有统计学意义(P<0.05);ICH组动脉瘤中线偏移>5 mm者占64.71%,明显高于ISH组的15.38%,差异有统计学意义(P<0.05);ICH组患者的动脉瘤角度分布范围大于ISH组,差异有统计学意义(P<0.05);ISH组9例预后良好,占69.23%,ICH组6例预后良好,占35.29%,差异有统计学意义(P<0.05);两组患者出院后WFNS分级量表和GCS评分比较差异均无统计学意义(P>0.05)。结论动脉瘤破裂合并侧裂内血肿与脑内血肿患者的临床特点、预后及影像学的差异较大,诊疗过程中应依据具体情况合理选取手术方式。

Objective To study the clinical features,prognosis and imaging features of ruptured middle cerebral artery(MCA)aneurysm combined with interhemispheric subdural hematoma and intracerebral hematoma.Methods A total of 30 patients with subarachnoid hemorrhage(SAH)accompanied by interhemispheric subdural hematoma(ISH)or intracerebral hemorrhage(ICH)caused by ruptured middle cerebral artery(MCA)aneurysm,who admitted to Baoji Hospital Affiliated to Xi'an Medical College from December 2014 to December 2019,were retrospectively analyzed.Among the 30 patients,there were 17 cases of ICH(ICH group)and 13 cases of ISH(ISH group).The gender,age,history of hypertension,systolic blood pressure,hematoma volume,aneurysm side,aneurysm size,αangle formed by the connection between MCA trunk and aneurysm origin and rupture at admission of the ICH and ISH patients were compared,and the World Federation of Neurologic Surgeons(WFNS)grading scale and Glasgow Coma Index(GCS)were used to evaluate the prognosis of the two groups after discharge.Results There was no statistically significant difference in hematoma side and aneurysm size(all P>0.05);the hematoma volume in the ICH group was(33.3±17.6)mL,which was significantly larger than(11.5±1.5)mL in the ISH group(P<0.05);in the ICH group,the midline offset of aneurysm>5 mm was 64.71%versus 15.38%in ISH group(P<0.05);the distribution range of angle of aneurysm in patients in ICH group was significantly larger than that of the ISH group(P<0.05).The cases of good prognosis of the ISH group were 9 cases(69.23%)versus 6 cases(35.29%)in the ICH group(P<0.05).There was no statistically significant difference in WFNS grading scale and GCS grading index between the two groups(P>0.05).Conclusion There are significant differences in clinical characteristics,prognosis and imaging of between patients with ruptured middle cerebral artery(MCA)aneurysm combined with interhemispheric subdural hematoma and intracerebral hematoma,so the operation mode should be selected according to the specific situation in the process of diagnosis and treatment.