超早期脑血管痉挛与动脉瘤性SAH后迟发性脑梗死的关系研究  

Relationship between ultra early stage cerebral vasospasm and delayed cerebral infarction after aneurysmal subarachnoid hemorrhage surgery

作　　者：郑亚东[1] 肖红 王岭梅[1] 许毅[1] 

机构地区：[1]重庆市急救医疗中心神经外科,400014

出　　处：《中华神经医学杂志》2017年第11期1098-1101,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨超早期脑血管痉挛与动脉瘤性蛛网膜下腔出血（sAH）后迟发性脑梗死的关系。方法选择重庆市急救医疗中心神经外科自2016年1月至10月收治的65例动脉瘤破裂所致SAH患者为研究对象。患者均行动脉瘤夹闭手术治疗，并在超早期（发病48h内）行颞窗双侧大脑中动脉M2段经颅多普勒（TCD）检查以确定有无脑血管痉挛。比较有无超早期脑血管痉挛患者围手术期急性生理与慢性健康评分Ⅱ（APACHE Ⅱ）评分、格拉斯哥昏迷评分（GCS）和发病2周内迟发性脑梗死发生率的差异，并采用诊断性试验四格表分析超早期脑血管痉挛预测迟发性脑梗死的价值。结果本组患者中超早期脑血管痉挛发生率为49．23％（32／65）。与无超早期脑血管痉挛组患者比较，有超早期脑血管痉挛组患者围手术期APACHEⅡ评分明显升高、GCS评分明显降低，迟发性脑梗死发生率明显升高，差异均有统计学意义fP〈0．05）。诊断性试验四格表分析显示，超早期脑血管痉挛预测迟发性脑梗死的敏感度、特异度、准确度分别为77.27％、65．12％和69．23％。结论动脉瘤性SAH患者超早期脑血管痉挛发生率较高，并在预测迟发性脑梗死方面有一定价值。Objective To investigate the relationship between ultra early stage cerebral vasospasm and delayed cerebral infarction after aneurysmal subarachnoid hemorrhage （SAH） surgery. Methods Sixty-five patients with aneurysmal SAH, admitted to our hospital from January 2016 to December 2016, were selected as research objects. The patients underwent aneurysm clip surgery and accepted middle cerebral artery M2 segment transcranial Doppler （TCD） in ultra early stage （within 48 h of onset） to determine the occurrence of vasospasm examination. Perioperative acute physiology and chronic health evaluation scale II （APACHE II） and Glasgow coma scale （GCS） scores and delayed cerebral infarction rate within 2 weeks in patients with different ultra early vasospasm occurrences were compared, and four-diagnostic tests were applied in analyzing the value of ultra early cerebral vasospasm in predicting postoperative delayed cerebral infarction. Results Ultra early vasospasm rate of the patients was 49.23% （32/65）. As compared with the patients without ultra early stage vasospasm, perioperative APACHE II scores and rate of delayed cerebral infarction of the patients with ultra early vasospasm were significantly increased, while GCS scores of the patients with ultra early vasospasm were significantly decreased （P〈0.05）. And the results of four diagnostic tests showed that the sensitivity, specificity and accuracy of ultra early stage cerebral vasospasm of the patients with aneurysmal SAH predicting the delayed cerebral infarction were 77.27%, 65.12% and 69.23%. Conclusion Ultra early stage cerebral vasospasm of the patients with aneurysmal SAH is high, which can evaluate the risk of postoperative delayed cerebral infarction.

关 键 词：颅内动脉瘤 蛛网膜下腔出血 迟发性脑梗死 脑血管痉挛 

分 类 号：R743.3[医药卫生—神经病学与精神病学]