自发性蛛网膜下腔出血全脑血管造影分析  

Analysis of digital subtraction angiography for the patients with spontaneous subarachnoid hemorrhage

作　　者：夏章勇[1] 杨华 王喜彬 曲怀谦[1] 宫殿荣[1] 亓立峰[1] 贾秀华[1] 

机构地区：[1]山东省聊城市人民医院神经内科,252000 [2]山东省聊城市第三人民医院神经内科,252000 [3]山东省龙口市边防检查站卫生队,265700

出　　处：《疑难病杂志》2007年第10期590-593,共4页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨数字减影全脑血管造影(DSA)对蛛网膜下腔出血(SAH)病因诊断的价值。方法对276例行DSA检查的SAH患者进行回顾性分析,根据发病后造影时间分为A(<24h)、B(1～3d)、C(4～14d)、D(>14d)4组,对其病因、造影时间、并发症等进行对照研究。结果276例SAH患者DSA病因诊断阳性率为71.4%,其中动脉瘤153例(55.5%),动静脉畸形28例(10.1%),动脉炎9例(3.3%),烟雾病7例(2.5%)。各年龄阶段动脉瘤都为最主要病因,而动静脉畸形、烟雾病在低龄患者中更为常见。动脉瘤好发部位依次为颈内动脉及分叉部、椎基底动脉及后交通动脉、大脑前动脉及前交通动脉。不同时程DSA的异常检出结果比较,B组与A组差异有统计学意义(P<0.05)。术后24h内并发症比较,A组再出血、脑积水、消化道出血、低钠血症、癫痫发作发生率高于其他各组;脑血管痉挛以C组发生率最高,下肢静脉血栓形成则以D组发生率最高。结论DSA对SAH病因诊断阳性率高,SAH患者病因诊断应常规行DSA检查,时间以发病1～3d为宜。Objective To investigate the value of digital subtraction angiography （DSA） in etiological diagnosis of spontaneous subarachnoid hemorrhage （SAH）. Methods The data of 276 patients with SAH who underwent DSA examination were retrospectively analyzed. The patients were divided into four groups according to the contrast time after disease attack： group A （ 〈 24 h）, group B （ 1 - 3 d）, group C （4-14 d）, group D （ 〉 14 d）, and their cause of disease, time of contrast examination and complication were comparatively studied. Results The positive rate of DSA in etiological diagnosis of 276 patients with SAIl was 71.4% ,including 153 cases （55.5%） of anemysm,28 cases （ 10.1% ） of arteriovenous malformation, 9 cases （3.3 % ） of arleritis and 7 cases（2.5 % ） of smog disease. Vascular tumor was main cause of disease among different age range, but arteriovehous malformation and smog disease were more common in low-age patients.The predilection sites of anemysm were internal carotid artery and forked site, veaebrobasilar and posterior communicating artery, anterior cerebral artery and anterior communieating artery. There was a significant difference in the .abnormality of DSA at different periolds between group B and group A （ P 〈 0.05）. The incidences of rehemorrhage, hydrocephalus, hemorrhage of digestive tract, hyponatruia and epileptic attack in group A were higher than the other groups. The incidence of eerebrovascular spasm was highest in group C among the four groups. The incidence of phlebotherombosis of leg was highest in group D. Conclusion The positive rate of DSA is high in etiological diagnosis. The patients with SAH should be regularly examined by DSA for etiological diag nasis. The suitable time of examination is one to three days after invasion.

关 键 词：出血 蛛网膜下腔 造影 全脑血管 数字减影 病因 诊断 

分 类 号：R743.3[医药卫生—神经病学与精神病学]