脑动静脉畸形出血相关因素探讨  

The study of related factors of brain arteriovenous malformation hemorrhage

作　　者：李明洙[1] 武文元[1] 张占普[1] 刘海波[1] 

机构地区：[1]呼和浩特内蒙古医学院附属医院神经外科,010050

出　　处：《中华神经外科杂志》2004年第3期228-231,共4页Chinese Journal of Neurosurgery

基　　金：内蒙古自治区科技攻关项目(20010213)

摘　　要：目的以本组脑AVM 120例,出血就诊85例为基础探讨脑AVM出血相关因素。方法随临床机遇脑AVM 120例。男82例,女38例,年龄8～62岁。病程5h～14年。以SAH及脑出血就诊85例(71.0%),二次及三次出血21例,占出血病例24.7%。DSA 115例,110例显见AVM(95.7%),隐匿性出血5例(4.4%)。据DSA、MRA检查,以综合分级,结合文献探讨脑AVM出血的相关或危险因素。结果Ⅰ、Ⅱ级(中、小型AVM)99例,出血79例,占出血组92.2%,Ⅲ、Ⅳ级(大型、超大型AVM)21例,出血6例,占7.1%。Ⅰ、Ⅱ级中、小型引流静脉数目少,引流简单,出血率最高。而Ⅲ、Ⅳ级大型、超大型引流静脉数目多,引流复杂,出血率低。结论脑AVM出血基础是病变血管的构筑及其形成的特殊血液动力学因素相互作用的结果,出血非为单一因素所决定。涉及出血相关因素或危险因素越多,出血率越高。脑AVM破裂出血与年龄、性别、AVM部位、供应动脉数目等并无明显关系。其中最主要的是与AVM大小、AVM构筑、引流静脉数目、大小流向、管壁损伤、缺陷程度、血流动力变化密切相关。动脉与静脉比较,引流静脉是AVM破裂主要因素。Objective To study the related factors about brain arteriovenous malformations (AVM) hemorrhage in 120 brain AVM patients, among whom 85 cases came to hospital because of hemorrhage. Methods 120 brain AVM cases were summarized and analyzed, 82 males and 38 females .Their ages were between 8 to 62 years old ,courses ranged from 5 hours to 14 years. Among them ,there were 85 cases (71.0%) came to hospital because of subarachnoid hemorrhage (SAH) and cerebral hemorrhage ,there were 21 cases who had hemorrhage history for two or three times, which accounted for 74.4% of all hemorrhage cases. Digital subtraction angifography (DSA) was used in 115 patients , 110 cases (95.7%) had apparent image of AVM . 5 cases(4.4%) were latent coronary brain AVM . The related factors of brain AVM were analyzed and studied by referred to other articles and DSA ,MRA examinations . Results TheⅠ?Ⅱ grade (medium and small type) were 99 cases ,79 cases had hemorrhage history ,which were 92.2% of hemorrhage group,The Ⅲ?Ⅳ grade (big and super big type)were 21 cases ,6 cases had hemorrhage history (7.1%).TheⅠ?Ⅱ grade brain AVM had relativly fewer and simpler drainage veins, while the Ⅲ?Ⅳ grade that belong to big and super big type brain AVM had more complex drainage veins, and its bleeding rate was lower. Conclusions The pathology of brain AVM bleeding was that interaction of dysplasia vessels and abnormal blood kinetics which occurred on them . The risk of bleeding was not determined by single factor , it was the result of interaction of multi-factors , the more the factors , the higher the risk .It had not apparent relationshop to age, sex, site and the quantity of supply arteries, but it related to the size and structure and constitution of AVM itself. The quantity, flowing direction, size of drainage veins, degree of vessels injury and deficiency and the changes of blood kinetice had very close relation to the brain AVM hemorrhage.

关 键 词：脑动静脉畸形出血 出血相关因素 血液动力学 危险因素 缺陷程度 

分 类 号：R651.1[医药卫生—外科学]