【作者】 马光涛；

【导师】 赵丛海；

【作者基本信息】 吉林大学 ， 临床医学， 2012， 硕士

【摘要】 自发性蛛网膜下腔出血(SAH)在普通人群中年发病率大约为8-10/10万人左右，占脑卒中的，发病率居脑血管意外的第3位，仅次于脑血栓形成和高血压脑出血存活者中三人之一留下中重度残废。它严重影响人类的生命安全及生活质量。本文通过收集大庆油田总医院神经外科自2008年9月至2011年9月我院手术及介入治疗181例自发性蛛网膜下腔出血（aSAH）病人的临床资料完整，其中包涵并发脑积水（急慢性）48份病例，并通过对其治疗结果及随访结果进行回顾性分析，综合分析了影响蛛网膜下腔出血(SA H)后脑积水的形成及治疗的各种因素。临床资料与方法：1临床资料1.1基本资料2008年9月至2011年9月我院手术及介入治疗181例动脉瘤性蛛网膜下腔出血（aSAH），其中并发脑积水（急慢性）48例，本组48例，男22例，女26例，年龄18-78岁。1.2既往史既往有高血压病史者58例，冠心病病史者23例，二者兼有者5例，有头痛病史者7例，13名高龄患者合并腔隙性脑梗塞及脑萎缩，10名患者合并糖尿病。1.3术前神经功能状态入院H unt-Hess分级：I级3例，II级8例，III级19例，IV级18例。SAH次数：1次者36例，2次者10例，3次者2例。SAH次数：1次者36例，2次者10例，3次者2例。2治疗方法所有的患者在入院后根据病情轻重在６ｈ－１４ｄ内行手术或介入治疗，行翼点入路或改良翼点入路手术治疗动脉瘤患者２６例（所有责任动脉瘤均在显微手术下直视夹闭）。经介入栓塞治疗手术患者２２例（均在发病３ｄ内完成介入栓塞治疗，操作过程中无动脉瘤破裂）。3治疗结果评价出院时结果分为：1、良好；2、轻残；3、重残；4、死亡。在出院结果统计分析中，将良好和轻残定为预后良好，将重残和死亡归入预后不良。治疗后恢复良好者33例，轻残8例，重残7例，死亡0例。4结论（1）急性脑积水其发病机制一般认为是蛛网膜下腔和脑池、脑室内的血液影响了中脑导水管、Monro孔、基底池乃至是整个脑室系统和蛛网膜下腔的脑脊液循环,而导致脑脊液循环通路的梗阻。慢性脑积水主要是由于脑室内出血改变了脑脊液循环的动力学,并在后期引起比较严重的蛛网膜下腔内纤维化所致。（2）脑积水的危险诱因包括性别（女性为多）、年龄、动脉的位置及大小，多发性动脉瘤；既往高血压病史和入院时血压增高，反复多次出血及出血后脑室积血，糖尿病，初次CT检查时脑室是否扩大,出血后的临床分级，吸烟、饮酒史等。（3）随着患者Hunt-hess分级及Fisher分级的增高，引起急性脑积水的概率便随之增高。（4）动脉瘤性蛛网膜下腔出血后脑积水的预防治疗首先应从起病时变应重视，将其预防治疗理念贯穿于整个治疗期间，通过保守治疗，预防性有创操作及手术治疗降低其发生率。更多还原

【Abstract】 Object:Based on hydrocephalus after aneurysmal subarachnoid hemorrhagestudied, to improve the cure rate of the patients.Methods:2008September to2011September in our hospital operation and interventi-onal treatment of181cases of subarachnoid hemorrhage (SAH), in whichconcurrent hydrocephalus (acute or chronic) in48cases,48cases of thisgroup,22were male,26female patients, age18-78years old.All of the patients in the hospital according to the severity of the6h14dadept operation or interventional therapy, line the pterional approach orimproved pterional approach operation treatment of aneurysms in26cases (allaneurysms were in microsurgical operation of direct clipping). Percutaneousinterventional embolization for the treatment of22cases of patients withoperation (both in the pathogenesis of3D complete embolization, duringoperation without aneurysm rupture).Result:At discharge, good results are divided into:1good;2, with mild residual;3,severe disability,4death;. At discharge statistic analysis of results, will be goodand residual light for good prognosis, will severely disabled and deathattributed to poor prognosis.After treatment,33cases had a good recovery,8cases of residual light,severe disability in7cases,0cases of death.Conclusion: Through this group of181patients retrospectively analysis, the followingconclusions can be drawn:1. acute hydrocephalus and its pathogenesis is subarachnoid and cerebralpool, intraventricular blood affects midbrain aqueduct, Monro hole, basalcistern and even whole intraventricular and subarachnoid cerebrospinal fluidcirculation, leading to the circulation of the cerebrospinal fluid pathwayobstruction. Chronic hydrocephalus is mainly due to intraventricularhemorrhage changed circulation of cerebrospinal fluid dynamics, and in thelater lead to serious within the subarachnoid space fibrosis cause.2. hydrocephalus risk factors include age, the position of the artery,anddiabetes mellitus, admission blood pressure increased, the initial CTexamination of ventricular enlargement and other relevant.3. As patients with Hunt-hess classification and Fisher levels increased,causing acute hydrocephalus subsequently increased probability of change.4. following aneurysmal subarachnoid hemorrhage hydrocephalusprevention treatment should first onset of allergic attention, its prevention andtreatment concept throughout the treatment period, the conservative treatment,prevention of invasive operation and operation treatment to reduce its incidence,improve the cure rate.5. chronic hydrocephalus shunt in treatment choice for V-P, SAH afterapproximately2week after cerebrospinal fluid is basic and normal, some casesmay be asymptomatic, to observe, in children and the special physique, can beconsidered the lateral ventricle-sagittal sinus shunt for treatment ofhydrocephalus.On hydrocephalus after subarachnoid hemorrhage prevention andtreatment, still some problems yet to be solved, we also need to work in the future to further research and discussion.更多还原