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目的探讨 Hunt-Hess Ⅳ～Ⅴ级蛛网膜下腔出血(SAH)的早期病因诊断方法及治疗原则,并客观评价其治疗效果。方法对31例 SAH 患者发病后7 d 内进行 CT 及 DSA 检查,寻找 SAH的原因,明确 SAH 均为脑动脉瘤破裂所致。明确病因后,即刻采用电解可脱性弹簧圈(GDC)进行动脉瘤囊内栓塞,术后早期处理出血并行有效的对症治疗。对于动脉瘤直径和瘤颈宽度不同患者的疗效和病死率进行比较,结果经χ~2检验。结果 31例患者经 CT、DSA 检查,均明确诊断。SAH 均为脑动脉瘤破裂所致,所有动脉瘤均经栓塞治疗。其中动脉瘤腔100%闭塞26例、95%闭塞者3例、90%闭塞者2例。术中并发脑血管痉挛5例,1例动脉瘤复发并经第2次补充 GDC 栓塞而治愈。29.0%(9/31)出现与 SAH 有关的永久性后遗症。治疗结果根据 Glasgow 预后评分:Ⅰ级6例、Ⅱ级9例、Ⅲ级4例、Ⅳ级2例、Ⅴ级10例;病死率32.3%(10/31)。术后随访3～68个月均无再出血。动脉瘤直径11～25 mm 组7例,死亡5例;5～10 mm 组21例,死亡4例,2组比较差异有统计学意义(χ~2=6.60,P<0.05)。瘤颈≤4 mm 组24例,动脉瘤完全栓塞23例,死亡5例;瘤颈>4 mm 组7例,动脉瘤完全栓塞3例,死亡5例,2组动脉瘤完全栓塞率和病死率差异均有统计学意义(分别χ~2=11.24、P<0.01,χ~2=6.35、P<0.05)。结论 CT 及 DSA 可对 Hunt-Hess Ⅳ～Ⅴ级 SAH 进行早期病因诊断;对已破裂的动脉瘤早期采用电解可脱性弹簧圈囊内栓塞,术后早期处理出血并有效的对症治疗,是提高动脉瘤性 SAH 治愈率和降低病死率及致残率的有效方法。
Objective To investigate the early etiological diagnosis and treatment principles of Hunt-Hess Ⅳ ~ Ⅴ subarachnoid hemorrhage (SAH) and objectively evaluate its therapeutic effect. Methods Thirty-one patients with SAH were examined with CT and DSA within 7 days after the onset of the disease. The reasons for SAH were determined. SAH was caused by rupture of cerebral aneurysm. A clear cause, the immediate use of detachable detachable coil (GDC) embolization of aneurysm sac, postoperative early treatment of bleeding in parallel with effective symptomatic treatment. For aneurysm diameter and tumor width in patients with different efficacy and mortality were compared, the results of χ ~ 2 test. Results 31 patients by CT, DSA examination, were diagnosed. SAH are caused by ruptured cerebral aneurysm, all aneurysms are embolized. Aneurysm in which 100% occlusion in 26 cases, 95% occlusion in 3 cases, 90% occlusion in 2 cases. Intraoperative cerebral vasospasm in 5 cases, 1 case of aneurysm recurrence and the second supplement of GDC embolization and cure. 29.0% (9/31) developed permanent sequelae related to SAH. According to the Glasgow prognosis score, 6 cases were grade Ⅰ, 9 cases were grade Ⅱ, 4 cases were grade Ⅲ, 2 cases were Ⅳ and 10 cases were Ⅴ. The case fatality rate was 32.3% (10/31). All patients were followed up for 3 to 68 months without rebleeding. There were 7 cases with aneurysm diameter from 11 to 25 mm in diameter and 5 cases died. There were 21 cases in 5 ~ 10 mm group and 4 cases died. The difference between the two groups was statistically significant (χ ~ 2 = 6.60, P <0.05). 24 cases of aneurysm ≤4 mm, 23 cases of complete embolization of aneurysm, 5 cases of death, 7 cases of tumor neck> 4 mm, 3 cases of aneurysm complete embolization, 5 cases of death, complete embolization rate and mortality of 2 groups The difference was statistically significant (χ ~ 2 = 11.24, P <0.01, χ ~ 2 = 6.35, P <0.05). Conclusions CT and DSA can be used to diagnose the early stage of Hunt-Hess grade Ⅳ ~ Ⅴ SAH. Embolization of ruptured aneurysm by early use of electrolytic detachable coil, early postoperative bleeding and effective symptomatic treatment are improved Aneurysmal SAH cure rate and reduce mortality and disability rate of effective methods.