56例PNSAH的临床特点和预后分析  

Clinical and prognostic analysis in 56 patients with perimesencephalic nonaneurysmal subarachnoid hemorrhage

作　　者：孙庆华[1,2] 宋竹茵[3] 尹琳[1] SUN Qing-hua SONG Zhu-yin YIN Lin(Department of Neurology, the Second Affiliated Hospital of Dalian Medical University, Dalian 116027, China Department of Neurology, People＇s Hospital of Dalian Zhongshan District, Dalian 116021, China Department of Neurology, Liaoning Provincial Hospital, Shengyang 110016, China)

机构地区：[1]大连医科大学附属第二医院神经内科,辽宁大连116027 [2]大连市中山区人民医院神经内科,辽宁大连116021 [3]辽宁省人民医院神经内科,辽宁沈阳110016

出　　处：《大连医科大学学报》2016年第5期462-466,共5页Journal of Dalian Medical University

摘　　要：目的对中脑周围非动脉瘤性蛛网膜下腔出血（PNSAH）的临床特点和预后进行分析。方法收集和整理2001年1月至2015年12月经CT和脑血管造影检查确诊的56例PNSAH的临床资料,其中男性27例,女性29例。所有病例均在入院1周内行脑血管造影（DSA）检查,并行控制血压,适度脱水降颅压,适量补充液体和电解质,防止离子紊乱,止痛、镇静等对症处理。对56例患者的临床经过、影像学特点及预后进行分析和总结。结果本组PNSAH患者男女比例接近1∶1;发病年龄20~69岁,中位年龄51.7岁,60岁以下占67.86%;56例中,51例于活动中发病,均以突然头痛、恶心为主要症状,33例伴有非喷射性呕吐,30例伴有颈项强直,均无意识障碍、抽搐及确切的神经系统局灶定位体征。56例PNSAH按Hunt-Hess分级：Ⅰ级24例,Ⅱ级31例,Ⅲ级1例、Ⅳ级0例。颅脑CT显示出血主要位于中脑周围池,其中脚间池26例,环池25例,桥前池18例,脚池11例,四叠体池5例,外侧裂3例。全部病例DSA检查结果均为阴性,1个月后复查DSA仍无阳性发现。56例患者经住院保守治疗均病愈出院。对其中39例病人进行了随访,平均随访89个月,未遗留局灶神经功能缺损,无再出血病例发生,生活质量良好。结论 PNSAH临床症状较轻,病情恢复较快,并发症少,预后良好,无再出血发生,对远期生活质量无明显影响。Objective To analyze the clinical features and prognosis of perimesencephalic nonaneurysmal subarachnoid hemorrhage（ PNSAH）. Methods Clinical data of 56 cases with PNSAH,which were admitted to our department from January 2001 to December 2015,were collected in this study. Each case was confirmed by cranial CT and DSA. All cases were treated conservatively including blood pressure control,moderate decreasing of intracranial pressure,balance of fluids and electrolytes,and symptomatic treatment as well. The clinical process,imaging features and prognosis were retrospectively investigated. Results Among 56 cases,27 were male and 29 female,aged 20 to 69 yrs with a mean age of 51. 7 yrs and 67. 86% cases less than 60 yrs. 51 cases had onset during activity with main symptoms of sudden headache and nausea. 33 cases had vomiting and 30 cases had neck stiffness. No case had consciousness disturbance and focal neurological deficits. Hunt- Hess grade at admission： grade I 24 cases,grade II 31 cases,grade III 1 case and grade IV 0 case. Crani-al CT showed that the blood was mainly distributed in mesencephalon surrounding cisterna and anterior pons pool. The blood spread into the quardigemina cistern and fissure of Sylvius in few cases. All cases had a negative DSA examination result performed within one week after onset,and repeated DSA were still negative performed one months later. All case recovered completely after conservative treatment. Long- term follow- up was available in 39 cases with a mean period of 89 months,no rebleeding or neurologic sequela was found. Conclusions PNSAH may cause mild clinical symptoms that will recover rapidly with few complications and good prognosis. Patients with PNSAH has very low risk of rebleeding and no influence on future quality of life.

关 键 词：中脑周围非动脉瘤性蛛网膜下腔出血 脑血管造影 临床特点 预后 

分 类 号：R743.35[医药卫生—神经病学与精神病学]