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目的探讨自发性蛛网膜下腔出血(SAHl造影最佳时机和治疗选择。方法选择我院自2000年1月至2007年1月收治的自发性SAH并行脑血管造影(DSA)的患者1015例,回顾性分析总结造影时机、出血原发病因、治疗方法及预后情况。结果发病24h以内造影者50例,1～3d造影者429例,3～7d造影者396例,7d～2周造影者77例,2周～1月造影者63例。动脉瘤768例,脑动静脉畸形12例,静脉畸形15例,自发性中脑周围出血50例,硬脑膜动静脉瘘11例,不明原因SAH 155例,MoyaMoya4例。动脉瘤血管内栓塞治疗692例,开颅夹闭67例,因多发动脉瘤等放弃病因治疗5例,术前再次出血死亡4例。脑动脉瘤中GOS评分5分730例,4分13例,3分10例,2分1例,1分14例。非动脉瘤性SAH中GOS评分均为5分。GOS评分4分以下的38例患者中,7d以后初次造影的为30例。结论对暂无生命威胁的SAH患者,尽早行DSA检查是尽快明确病因,正确选择治疗方法,获得良好转归的重要保证。
Objective To explore the optimal timing and treatment options for spontaneous subarachnoid hemorrhage (SAH) .Methods A total of 1015 patients with spontaneous SAH concurrent cerebral angiography (DSA) were enrolled in our hospital from January 2000 to January 2007, Retrospective analysis summarized the timing of angiography, the primary cause of bleeding, treatment and prognosis.Results 50 cases of angiography within 24h, 429 cases of 1 ~ 3d angiography, 396 cases of 3 ~ 7d angiography, 77 days of angiography Cases, 2 weeks to January angiography in 63 cases.Anoma 768 cases, cerebral arteriovenous malformations in 12 cases, 15 cases of venous malformations, spontaneous midbrain hemorrhage in 50 cases, 11 cases of dural arteriovenous fistula, unexplained SAH 155 Cases, MoyaMoya4 cases.Abdominal embolization of aneurysm in 692 cases, craniotomy closed 67 cases, due to multiple aneurysms to give up the cause of treatment in 5 cases, 4 cases of bleeding again before surgery bleeding.Gas aneurysm in GOS score 5 points 730 cases , 4 points and 13 cases, 3 points and 10 cases, 2 points and 1 case, and 1 point and 14 cases.The GOS scores of non-aneurysmal SAH were all 5. Among the 38 cases with GOS score less than 4, among the 7 cases, In 30 cases.Conclusion DSA is the fastest way to diagnose the SAH patients without any life threatening.And the correct choice of treatment is obtained Improved return of an important guarantee.