【作者】 柳敬伟；

【导师】 朱晓波；

【作者基本信息】 吉林大学 ， 外科学， 2009， 硕士

【摘要】 蛛网膜下腔出血(Subarachnoid Hemorrhage,SAH)是出血性脑血管病的一个类型,多见于先天性颅内动脉瘤和脑血管动静脉畸形,前者最多见。其他原因有高血压、脑动脉硬化、颅内肿瘤、血液病、脑底异常血管网症(moya-moya病)、动脉炎、脑炎、脑膜炎及抗凝治疗的并发症等。SAH后可引起一系列的并发症,如再出血、脑血管痉挛、脑积水,部分患者可有癫痫发作、上消化道应激性出血、肺水肿等。再出血、脑血管痉挛、脑积水是SAH后严重的并发症,也是SAH病人致死、致残的主要原因。因此应在这些并发症出现之前应及早对其进行防治。如已经发生,应尽早查明病因,积极治疗原发病及并发症,改善预后。本文通过本组临床资料发现蛛网膜下腔出血好发年龄在40-60岁,女性多见。动脉瘤破裂是SAH的主要原因。由于引起SAH的原因不同,所以治疗方法不同。故应尽早查明病因,根据不同病因采取相应的治疗手段。CT对SAH的诊断率高,对于SAH的病因诊断可首选CTA检查。再出血、脑血管痉挛、脑梗塞、脑积水是SAH的主要并发症。任何一个并发症都有可能带来严重后果,甚至死亡。所以在治疗原发病的同时,同样不可忽视对SAH并发症的预防和治疗。更多还原

【Abstract】 SAH is one of the hemorrhagic cerebrovascular diseases, butit is particularly prevalent in the congenital intracranial aneurysms and cerebral vascular malformation, Up to see the former. Other reasons are hypertension, cerebral arteriosclerosis, brain tumor, blood disease, moyamoya disease networks (moya-moya disease), arteritis, encephalitis, meningitis and complications such as anticoagulant therapy. SAH can caused a series of complications.Such as re-bleeding, cerebral vasospasm, hydrocephalus, Some patients have epileptic seizures, stress-induced upper gastrointestinal bleeding, pulmonary edema, etc. Re-bleeding, cerebral vasospasm, hydrocephalus are serious complications after SAH. And they are also the main reasons about died and disability. Therefore it should be carried out as soon as possible to combat before the appearance of these complications. If it has occurred, Should be identified causes as soon as possible, treatment complications of the primary disease and improve the prognosis. In this paper, the clinical data found in this group hemorrhage subarachnoid hemorrhage occurred in 40-60 year-old age. Mostly women. Aneurysm rupture is the main reason for SAH. As a result of SAH is caused by different reasons, so it shuod take different treatment methods. So it should be identified causes as soon as possible, according to different causes to take the appropriate means. CT diagnosis is a high rate of SAH, the diagnosis for the causes of SAH can be the preferred CTA examination. Re-bleeding, cerebral vasospasm, cerebral infarction, hydrocephalus are major complications of SAH.Any of complications is likely to bring about serious consequences and even death. Therefore, in the treatment of primary disease, it can not be ignored in the prevention of complications of SAH and treatment at the same time.Objective: To investigate the clinical features of subarachnoid hemorrhage and the prevention and control measures.Methods: Retrospective analysis of the First Clinical Hospital of Jilin University neurosurgery 2 January 2006 to February 2009 treated 206 cases of clinical data of patients with subarachnoid hemorrhage.Results: Traumatic SAH10.7%, spontaneous SAH89.3%. The age is 16 to 75 years old, average age is 55 years. In these people, 16 to 30-year-old is 14.1%, 31~40-year-old is 17.5%, 41~50-year-old is 28.6%, 51~60-year-old is 32.5%, 61~75-year-old is 7.3%. 40~60-year-old 126 cases, is about 62.3%. Spontaneous SAH in 40~60-year-old 119 is cases, accounting for the incidence of spontaneous SAH of 64.7%. 40~60-year-old can be seen the most age in spontaneous subarachnoid hemorrhage . people of 69.9 percent have prior to the onset of significant incentives, Large quantities of alcohol is 5.3 percent, long-term heavy smoking (20 cigarettes/day) 21.9%, emotional movements or 29.1 percent, forced defecation 3%. In the cause of spontaneous SAH, the AN81.7%; AVM4.3%; MMD2.3%; of 11.7% of unknown causes. Aneurysmal SAH, men is 34.9%, female is 65.1%. Through statistical analysis, aneurysmal subarachnoid hemorrhage compared the incidence of gender, women is more than men (X2=4.24, P <0.05), it is difference. Clinical manifestations, 91.2% has headache, vomiting is 47.6%, 12.7% has hemiplegia, oculomotor palsy is 7.3%, meningeal irritation-positive is 79.1%, 13.1% has seizure, 9.2% has consciousness. SO headache and meningeal irritation are major symptoms and signs of SAH. To take CTA examination is 154 cases, diagnostic accuracy cause is 96.8%. So it can be used as the first choice for SAH etiological diagnosis. In treatment, in addition to medical treatment, it shuod take surgical methods to different causes. Aneurysm clipping surgery and parcel are 162 (clipping 155, parcel 7), internal carotid artery ligation is 2 cases, 94.1% are healed in aneurysm. Moyamoya disease is used brain - temporal muscle attached for treatment, three cases has good restoration, only have slightly varying degrees of neurological dysfunction, 1 patient dropped out. Arteriovenous malformation surgery are to achieve total resection, one case of postoperative hemiparesis is still varying degrees. Two cases ae physical activity barriers. In these 176 cases of surgery (including AN152 cases, AVM8 cases, MMD4 cases), operative mortality is zero.Conclusion: In subarachnoid hemorrhage, spontaneous subarachnoid hemorrhage is the most. And it make a high rate in the age of 40-60 years old, angd woman is more. First symptom is headache and (or) nausea and vomiting. Meningeal irritation is Common signs. Aneurysm is the main reason for spontaneous subarachnoid hemorrhage. CTA may be the preferred choise for etiological diagnosis of subarachnoid hemorrhage. As the cause of the diagnosis and treatment technologies about subarachnoid hemorrhage are improved, the mortality and disability has been greatly reduced ,such as AN, MMD, AVM has been reduced to zero operative mortality.更多还原