动脉瘤性蛛网膜下腔出血致延迟性缺血性神经功能障碍的临床特点及早期诊治  

Clinical feature,early diagnosis and therapy of delayed ischemic neurologic deficits after aneurysmal subarachnoid hemorrhage

作　　者：宋锦宁[1] 刘守勋[1] 王拓[1] 鲍刚[1] 隋龙[1] 李琦[1] 郗磊[1] 徐高峰[1] 谢昌厚[1] 

机构地区：[1]西安交通大学医学院第一附属医院神经外科,陕西西安710061

出　　处：《中国现代医学杂志》2008年第17期2510-2513,共4页China Journal of Modern Medicine

基　　金：国家高技术研究发展计划"863计划"资助课题(No:2006AA02Z4Z4);教育部高层次创造性人才计划<新世纪优秀人才支持计划>资助课题(No:NCET-05-0831);陕西省科学技术研究发展攻关计划基金资助项目(No:2002K10-G1-9)

摘　　要：目的探讨动脉瘤性蛛网膜下腔出血(SAH)后延迟性缺血性神经功能障碍(DIND)的临床特点及早期诊治方法。方法对41例动脉瘤性SAH患者采用CT、经颅多普勒超声(TCD)及DSA等检查,总结分析其临床特点,并结合临床进行DIND的早期诊断;对动脉瘤性SAH患者早期进行病因治疗,并对已形成DIND者早期应用钙拮抗剂以及升高血压、高血容量、血液稀释的"3H"治疗。结果全组41例均被诊断为DIND。其治疗结果根据Glasgow预后评分:Ⅰ级10例,Ⅱ级12例,Ⅲ级11例,Ⅳ级3例,Ⅴ级5例;死亡率12.2%。结论动脉瘤性SAH后DIND是多因素造成的,尤其与脑血管痉挛有密切关系,只有当脑血流量下降到引起脑缺血的临界水平以下时才能形成DIND;采用CT、TCD及DSA等检查,并结合临床表现可以对DIND进行早期诊断;早期进行病因治疗、提高脑灌注压、降低血黏稠度、解除脑血管痉挛以及逆转脑缺血半暗区等早期治疗是提高动脉瘤性SAH后DIND治愈率、降低死亡率和致残率的关键环节。[Objective] To discuss the clinical features, early diagnosis and therapy methods of delayed ischemic neurologic deficits（DIND） after aneurysmal subarachnoid hemorrhage（SAH）. [Methods] Using the CT, TCD, DSA etc to examine 41 cases of aneurysmal SAH patients, to summarize and analyze its chnical features, and then early diagnosed DIND according to the clinical features. Early using the Calcium channel blockers and triple-H therapy that is hypervolemia, hemodilution, hypertention to treat the patients with DIND. [Results] The whole group of 41 cases were all diagnosed DIND. According to the Glasgow outcome score, the therapeutic efficacy was that： 10 pa- tients were in grade Ⅰ, 12 cases were in grade Ⅱ, 11 cases were in grade Ⅲ, 3 cases were in grade Ⅳ, 5 cases were in grade V. The mortality rate was 12.2%. [Conclusions] DIND was associated with multiple factors after a- neurysmal SAH, especially having the intimate relation with cerebral vasospasm, when cerebral blood flow decreased below the critical level of causing cerebral ischemia Cerebral vasospasm can form DIND; Using the CT, TCD, DSA etc to examine and early diagnosed DIND according to the clinical features, the early therapy of increasing the cere- bral perfusion pressure, decreasing the blood viscidity, removing the cerebral vasospasm and reversing the cerebral isehemie penumbra is the key point to increasing the cure rate and decreasing the mortality rate and the mutilation rate of DIND after aneurysmal SAH.

关 键 词：颅内动脉瘤 蛛网膜下腔出血 延迟性缺血性神经功能障碍 诊断 治疗 

分 类 号：R743.35[医药卫生—神经病学与精神病学]