动脉瘤性蛛网膜下腔出血对脑静脉循环的影响

Effects of aneurysmal subarachnoid hemorrhage on cerebral venous circulation

目的探讨动脉瘤性蛛网膜下腔出血(aSAH)对脑静脉循环的影响。方法2014年7月至2016年1月收集aSAH共57例(aSAH组)、颅内未破裂动脉瘤48例(未破裂组)、非动脉瘤病人45例(正常对照组);aSAH病人依据入院时GCS评分分为重型组(GCS评分3~12分)和轻型组(GCS评分13~15分)。利用DSA观察脑微循环时间(mCCT)、脑静脉循环时间(vCCT)、脑微血管和皮质静脉的显影特征。结果与未破裂组与正常对照组相比,aSAH组mCCT、vCCT均明显延长(P<0.05);病情越重,mCCT和vCCT延长越明显(P<0.05)。未破裂组与正常对照组mCCT及vCCT均无统计学差异(P>0.05)。51例aSAH病人DSA可见不同程度的显影较浓的“毛玻璃征”或显影瘀滞及皮质静脉显像不光滑的征象。结论aSAH急性期存在脑微循环时间延长,病情越严重,时间延长越明显。

Objective To analyze the changes of cerebral venous circulation in the patients with aneurysmal subarachnoid hemorrhage(aSAH)by the DSA imaging.Methods Fifty-seven patients with aSAH(aSAH group),48 with intracranial unruptured aneurysms(unruptured group)and 45 without intracranial aneurysms(control group)were collected from July 2014 to January 2016.The patients in aSAH group were divided into severe group(GCS score 3~12)and mild group(GCS score 13~15).The cerebral microcirculation time(mCCT),cerebral venous circulation time(vCCT),cerebral microcirculation and cortical vein were observed and calculated using the DSA images.Results The mCCT and vCCT of aSAH group significantly prolonged compared with those of unruptured and control groups(P<0.05).The mCCT and vCCT of severe group significantly prolonged compared with those of mild group(P<0.05).There was no significant difference in the mCCT and vCCT between unruptured and control groups(P>0.05).The DSA of 51 aSAH patients showed hairy glass sign,development stasis and non-smooth signs of cortical vein.Conclusions The cerebral microcirculation time significantly increase in the acute phase of aSAH.The more serious the condition of aSAH patients,the more obvious the prolongation of cerebral microcirculation time.