动脉瘤破裂致自发性蛛网膜下腔出血继发脑积水的危险因素分析  

Analysis of risk factors of hydrocephalus after spontaneous subarachnoid hemorrhage

作　　者：郭堂军 施恒亮 张桐 解哨 GUO Tangjun;SHI Hengliang;ZHANG Tong;XIE Shao(Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州医科大学附属医院,江苏徐州221000

出　　处：《中国实用神经疾病杂志》2020年第24期2140-2145,共6页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然科学基金面上项目(编号:81874081)。

摘　　要：目的分析动脉瘤破裂致自发性蛛网膜下腔出血患者继发脑积水的危险因素,探讨其临床症状、治疗方法及预后。方法选取徐州医科大学附属医院神经外科2017-01—2019-12入院的动脉瘤破裂性蛛网膜下腔出血患者153例,对其中继发脑积水的38例患者临床资料进行回顾性分析,探讨其继发脑积水的危险因素。结果可能影响动脉瘤破裂性蛛网膜下腔出血患者继发脑积水的危险因素主要有Fisher分级、Hunt-Hess分级、动脉瘤出血部位、出血次数、术中引流方式等。38例患者通过分别实施脑室钻孔外引流、脑室腹腔分流术等治疗,经格拉斯哥预后评分(GOS)痊愈良好20例,轻度残疾13例,重度残疾3例,植物生存2例。结论对于动脉瘤性蛛网膜下腔出血,外科夹闭术中适当地引流、及时地清除积血、术后持续的脑脊液引流有利于降低术后继发脑积水的风险,提高临床治疗效果及患者生存质量。Objective To analyze risk factors of hydrocephalus after spontaneous subarachnoid hemorrhage(sSAH),and to explore its clinical characteristics,treatment and outcome.Methods Totally 153 sSAH patients were randomly selected from our hospital neurosurgery in January 2017 to December 2019,including 38 hydrocephalus patients whose clinical diagnosis and treatment data were analyzed retrospectively.Results The main risk factors of hydrocephalus after sSAH includingHunt-Hess classification,Fisher classification,aneurysm location,repeated hemorrhage and drainage.38 patients were treated with the implementation of ventricle drainage or V-P shunt,whose GOS score showed that 20 cases recovered well,13 cases were mild invalid,3 cases were severely disabled,and 2 cases were persistent vegetative state.Conclusion According to the patients selected in the clinical treatment,surgical operation treatment and drainage can reduce the morbidity of postoperative patients and to improve the clinical therapeutic effect.

关 键 词：自发性蛛网膜下腔出血 脑积水 危险因素 动脉瘤 GOS预后评分 

分 类 号：R739.41[医药卫生—肿瘤]