自发性蛛网膜下腔出血274例临床分析

CLINICAL STUDY OF SPONTANEOUS SUBARACHNOID HEMORRHAGE (REPORT OF 274 CASES)

目的 :探讨自发性蛛网膜下腔出血 (SAH)患者的临床特征。方法 :回顾性分析了 1986～ 2 0 0 0年湘雅医院2 74例SAH住院患者的病因、临床表现、CT和血管造影检查结果。结果 :病因 :动脉瘤 112例 (40 .9% ) ,以 4 5～ 5 9岁组最多见 (P <0 .0 1) ;血管畸形 33例 (12 .1% ) ,小于 4 5岁组中多见 (P <0 .0 1) ;高血压动脉硬化 5 0例(18.3% ) ,主要集中在大于 6 0岁组 (P <0 .0 1)。临床表现 :头痛、呕吐、颈抗阳性在中青年SAH患者中的发生率显著高于老年患者 ;而意识障碍和肢体瘫痪症状在老年患者中发生率较高。头部CT检查阳性率79.6 6 % (14 1/ 177)。本组病人治愈 138例 (5 0 .4 % ) ,好转 83例 (30 .3% ) ,恶化 2 5例 (9.1% ) ,死亡 2 8例(10 .2 % )。结论 :青中年SAH患者的主要病因是动脉瘤和血管畸形 ,而老年患者为高血压动脉硬化 ;老年SAH患者的临床表现不如中青年患者典型 ;CT是首选检查方法 ,血管造影对明确病因意义重大。

Objective:To explore clinical characteristics of spontaneous subarachnoid hemorrhage (SAH) patients.Methods:We analyzed the etiologies, clinical manifestations and results of CT and DSA of 274 SAH patients of different ages in Xiangya Hospital from 1986 to 2000. Results: The etiologies we found included aneurysm (112 cases, 40.9%; mainly in the 45～59 years old group), artery malformation (33 cases, 12.1%; mainly in the under 45 years old group), and hypertensive arteriosclerosis (50 cases, 18.3%; mainly in the above 60 years old group). The clinical manifestations consisted of headache, vomiting, disturbance of consciousness, cervical rigidity and limb paralysis, which were significant differences among different age groups and there were 138 healed cases (50.4%). 83 improved cases (30.3%), 25 deteriorated cases (9.1%) and 28 died cases (10.2%).Conclusion:The main causes of SAH of young patients are aneurysm and vascular malformations, and to the old is hypertensive arteriosclerosis. The clinical manifestations of the old are not as typical as the young. CT is the first choice to confirm SAH, while DSA is very important to find the etiology.