CAJ | 학술논문

目的探讨GDC血管内栓塞治疗动脉瘤性蛛网膜下腔出血后慢性脑积水发生的易患因素和临床预后.方法纳入研究标准的132例动脉瘤性蛛网膜下腔出血患者均行GDC血管内栓塞治疗,术后对出血破入脑室伴脑室系统梗阻患者行脑室外引流术,对其他患者行腰椎穿刺脑脊液置换术,出血后1月CT评价慢性脑积水发生情况.对慢性轻度脑积水行短期临床观察,慢性重度脑积水行脑室腹腔分流术.根据改良Rankin量表评价患者6月后临床恢复情况.行统计学分析明确影响慢性脑积水发生的易患因素,比较动脉瘤性蛛网膜下腔出血治疗6月后有无慢性脑积水者在临床预后上的差异.结果本组动脉瘤性蛛网膜下腔出血患者慢性脑积水的发生率为12.12%(16/132),其易患因素依次是年龄、术前Fisher分级、术前Hunt-Hess分级.GDC血管内栓塞治疗后6月随访,有无慢性脑积水者在临床预后方面差异无统计学意义(P>0.05).结论动脉瘤性蛛网膜下腔出血后慢性脑积水的发生不是单因素作用的结果,重度慢性脑积水患者及时行脑室腹腔分流术可得到较好的预后结果.
목적 탐토GDC혈관내전새치료동맥류성주망막하강출혈후만성뇌적수발생적역환인소화림상예후.방법 납입연구표준적132례동맥류성주망막하강출혈환자균행GDC혈관내전새치료,술후대출혈파입뇌실반뇌실계통경조환자행뇌실외인류술,대기타환자행요추천자뇌척액치환술,출혈후1월CT평개만성뇌적수발생정황.대만성경도뇌적수행단기림상관찰,만성중도뇌적수행뇌실복강분류술.근거개량Rankin량표평개환자6월후림상회복정황.행통계학분석명학영향만성뇌적수발생적역환인소,비교동맥류성주망막하강출혈치료6월후유무만성뇌적수자재림상예후상적차이.결과 본조동맥류성주망막하강출혈환자만성뇌적수적발생솔위12.12%(16/132),기역환인소의차시년령、술전Fisher분급、술전Hunt-Hess분급.GDC혈관내전새치료후6월수방,유무만성뇌적수자재림상예후방면차이무통계학의의(P>0.05).결론 동맥류성주망막하강출혈후만성뇌적수적발생불시단인소작용적결과,중도만성뇌적수환자급시행뇌실복강분류술가득도교호적예후결과.
Objective To explore the risk factors and the prognosis of chronic hydrocephalus following aneurysmal subarachnoid hemorrhage (SAH) treated by endovaseular embolization with Guglielmi detachable coils (GDCs). Methods Endovascular embolization with GDCs were performed in 132 patients with aneurysmal subarachnoid hemorrhage that satisfied our research standard. After endovascular embolization, ventricular drainage was conventionally performed in patients who occurred intraventricular hemorrhage combined with obstruction in the ventricular system, while cerebrospinal fluid permutation was performed in other patients. Chronic hydrocephalus was evaluated by CT 1 month after SAH. Ventricle-peritoneal shunt was carried out for patients with severe chronic hydrocephalus while only clinical observation was needed for patients with mild chronic hydrocephalus. Clinical follow-up evaluation was carried out 6 months after SAIl according to the modified Rankin scale score. The risk factors related to chronic hydrocephalus were noted through the statistical analysis of the patients' data and the relation between the appearing of chronic hydrocephalus and clinical prognosis of SAH was analyzed. Results The overall incidence rate of chronic hydrocephalus following aneurysmal subarachnoid hemorrhage was 12.12% and age, Fisher grade and Hunt-Hess grade had important value in the prognosis of chronic hydrocephalus. Clinical prognosis of SAH was not significantly related to chronic hydrocephalus following SAH (P >0.05). Conclusion Chronic hydrocephalus following aneurysmal subarachnoid hemorrhage is not only resulted from one single risk factor and good clinical prognosis can be achieved by promptly performing ventricle-peritoneal shunt in patients with severe chronic hydrocephalus.