破裂出血动脉瘤的早期栓塞治疗与脑血管痉挛  

Symptomatic cerebral vasospasm after early treatment of acutely ruptured aneurysms by endovascular embolization

作　　者：洪波[1] 刘建民[1] 许奕[1] 张珑[1] 黄清海[1] 赵文元[1] 周晓平[1] 

机构地区：[1]上海第二军医大学长海医院神经外科,200433

出　　处：《介入放射学杂志》2004年第S1期7-9,共3页Journal of Interventional Radiology

基　　金：国家自然科学基金;3 0 10 0 194

摘　　要：目的　分析血管内栓塞治疗急性破裂出血动脉瘤脑血管痉挛的发生及治疗。方法　Hunt HessⅠ～Ⅲ级并在发病后 72h内进行介入治疗的动脉瘤患者 32 9例 ,症状性血管痉挛的诊断根据迟发性神经功能损害 ,并有TCD和 (或 )脑血管造影的证据。结果　共发生症状性血管痉挛 6 2例 (18.2 % ) ,血管痉挛的发生率和Hunt Hess分级及Fisher分级有显著的相关关系 ,6 2例发生症状性脑血管痉挛患者中恢复良好 4 1例 ,中度致残 13例 ,重度致残 6例 ,死亡 2例。结论　GDC栓塞治疗动脉瘤后症状性血管痉挛的发生率并不高于常规手术治疗 ;放置腰椎蛛网膜下腔持续引流可能对降低症状性脑血管痉挛的发生有积极意义。Objective We analyzed the incidence and treatment of symptomatic vasospasm after early endovascular therapy of ruptured aneurysms by endovascular embolization.Methods 329 patients classified as Hunt-Hess grades Ⅰto Ⅲ were embolized within 72 hours after aneurysm rupture. Symptomatic vasospasm was diagnosed as the onset of delayed neurological deterioration with evidence of angiographic or transcranial Doppler studies. Results Symptomatic vasospasm occurred in 62 patients (18.2%). Both Hunt-Hess grade and Fisher's scale before treatment correlated with the incidence of cerebral vasospasm. Among the 62 patients suffered from symptomatic vasospasm, 41 patients recovered well, 13 were moderately disabled, 6 were severely disabled and 2 patients died. Conclusions The incidence of symptomatic vasospasm was relatively low as compared to conventional open surgery. lumber puncture cerebral spinal fluid drainage may play an important role in reducing the incidence of cerebral vasospasm.

关 键 词：颅内动脉瘤 脑血管痉挛 蛛网膜下腔出血 血管内治疗 

分 类 号：R739.4[医药卫生—肿瘤]