动脉瘤性蛛网膜下腔出血后脑血管痉挛与延迟性缺血性神经功能障碍的相关性  

Relationship between cerebral vasospasm and delayed ischemic neurological deficit

作　　者：李珉[1] 胡颖红[1] 陈高[2] 

机构地区：[1]浙江大学医学院附属第二医院脑重症医学科,浙江杭州31009 [2]浙江大学医学院附属第二医院神经外科,浙江杭州31009

出　　处：《浙江大学学报（医学版）》2006年第2期215-218,共4页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省自然科学基金资助项目(Y204208)

摘　　要：目的:探讨脑血管痉挛与延迟性缺血性神经功能障碍(D IND)发生之间的相关关系。方法:回顾分析5年中118例动脉瘤性SAH患者,脑血管痉挛的发生和严重程度及部位与D IND发生之间的关系,以及D IND与脑梗死影像学检查的一致性。结果:脑血管痉挛与D IND两者之间存在弱相关(r=0.22;P=0.016);随着痉挛程度加重,D IND发生率增加(U=2.589,P<0.05)。大脑中动脉痉挛组的D IND发生率为68.0%,高于大脑前动脉和颈内动脉痉挛组的36.7%和25.0%(2χ=8.195,P=0.004);而后两组差异无显著性(χ2=0.646,P=0.421)。结论:脑血管痉挛只是D IND发生的重要因素之一;重度脑血管痉挛时和大脑中动脉部位的痉挛,才易发生D IND;发生于非重要功能区脑缺血,可能无D IND临床表现。Objective： To investigate the relationship between, cerebral vasospasm and occurrence of delayed ischemic neurological deficit （DIND）. Methods： The clinical records and radiographic images of 118 patients with subarachnoid hemorrhage admitted during last 5 years were reviewed. The incidence, degree and localization of cerebral vasospasm were evaluated, and morbidity of related DIND was analyzed. Patients with cerebral vasospasm were divided into three groups： Group MCA （middle cerebral artery）, Group ACA （anterior cerebral artery） and Group ICA （intracranial carotid artery） according to the location of cerebral vasospasm. The consistency of DIND and image of cerebral infarction were examined. Results： There was a weak correlation between cerebral vasospasm and incidence of DIND （r = 0.22; P = 0.016）. The incidence of DIND was increased with severity of cerebral vasospasm （U = 2.589, P〈0.05）. The group MCA had a significantly higher incidence of DIND than that of ACA and ICA groups （68.0% vs 36.7% and 25.0%, respectively, X^2 = 8.195, P = 0.004）, the difference between later two groups was not statistically significant （X^2 = 0.646, P = 0.421）. Conclusion： Cerebral vasospasm may be an important factor leading to DIND occurrence; the severity and location of cerebral vasospasm is related to the incidence of DIND.

关 键 词：血管痉挛 颅内 蛛网膜下腔出血 脑血管痉挛 延迟性缺血性神经功能障碍 

分 类 号：R743[医药卫生—神经病学与精神病学]