中华神经外科疾病研究杂志
中華神經外科疾病研究雜誌
중화신경외과질병연구잡지
Chinese Journal of Neurosurgical Disease Research
2015年
4期
307-311
,共5页
郭芳%张铭%李中振%梁恩和
郭芳%張銘%李中振%樑恩和
곽방%장명%리중진%량은화
分流依赖性脑积水%动脉瘤性蛛网膜下腔出血%危险因素%Fisher分级系统
分流依賴性腦積水%動脈瘤性蛛網膜下腔齣血%危險因素%Fisher分級繫統
분류의뢰성뇌적수%동맥류성주망막하강출혈%위험인소%Fisher분급계통
Shunt-dependent hydrocephalus%Aneurysmal subarachnoid hemorrhage%Risk factors%Fisher grade system
目的：探讨动脉瘤性蛛网膜下腔出血（ aneurysmal subarachnoid hemorrhage， aSAH）后分流依赖性脑积水（ shunt-dependent hydrocephalus， SDHC）的危险因素，比较Fisher分级系统中开颅动脉瘤夹闭或血管内栓塞对aSAH后SDHC的影响。方法回顾性分析我院2011年7月至2014年6月收治的768例经开颅夹闭或血管内栓塞治疗的aSAH患者的临床资料，分为分流组（151例）与非分流组（617例）探讨SDHC的危险因素，并根据Fisher分级系统，分析不同治疗方式对SDHC的影响。结果 SDHC发生的危险因素包括：年龄大于等于40岁，Hunt-Hess（ H-H）分级Ⅲ、Ⅳ、Ⅴ级，Fisher分级Ⅲ、Ⅳ级，急性脑积水，脑室内出血（ intraventricular hemorrhage， IVH）。 Fisher分级Ⅱ级的患者，栓塞治疗有较低的SDHC发生率；Fisher分级Ⅳ级的患者，开颅夹闭治疗有较低的SDHC发生率。结论SDHC的高发生率与患者的高龄、较差的起始神经系统状态、急性脑积水、脑室内出血有关。 Fisher分级Ⅱ级的患者选取栓塞治疗，Ⅳ级的患者选取夹闭治疗，可明显降低SDHC发生，改善患者预后；Fisher分级Ⅰ、Ⅲ级的患者，两种治疗方式对SDHC的发生无影响。
目的：探討動脈瘤性蛛網膜下腔齣血（ aneurysmal subarachnoid hemorrhage， aSAH）後分流依賴性腦積水（ shunt-dependent hydrocephalus， SDHC）的危險因素，比較Fisher分級繫統中開顱動脈瘤夾閉或血管內栓塞對aSAH後SDHC的影響。方法迴顧性分析我院2011年7月至2014年6月收治的768例經開顱夾閉或血管內栓塞治療的aSAH患者的臨床資料，分為分流組（151例）與非分流組（617例）探討SDHC的危險因素，併根據Fisher分級繫統，分析不同治療方式對SDHC的影響。結果 SDHC髮生的危險因素包括：年齡大于等于40歲，Hunt-Hess（ H-H）分級Ⅲ、Ⅳ、Ⅴ級，Fisher分級Ⅲ、Ⅳ級，急性腦積水，腦室內齣血（ intraventricular hemorrhage， IVH）。 Fisher分級Ⅱ級的患者，栓塞治療有較低的SDHC髮生率；Fisher分級Ⅳ級的患者，開顱夾閉治療有較低的SDHC髮生率。結論SDHC的高髮生率與患者的高齡、較差的起始神經繫統狀態、急性腦積水、腦室內齣血有關。 Fisher分級Ⅱ級的患者選取栓塞治療，Ⅳ級的患者選取夾閉治療，可明顯降低SDHC髮生，改善患者預後；Fisher分級Ⅰ、Ⅲ級的患者，兩種治療方式對SDHC的髮生無影響。
목적：탐토동맥류성주망막하강출혈（ aneurysmal subarachnoid hemorrhage， aSAH）후분류의뢰성뇌적수（ shunt-dependent hydrocephalus， SDHC）적위험인소，비교Fisher분급계통중개로동맥류협폐혹혈관내전새대aSAH후SDHC적영향。방법회고성분석아원2011년7월지2014년6월수치적768례경개로협폐혹혈관내전새치료적aSAH환자적림상자료，분위분류조（151례）여비분류조（617례）탐토SDHC적위험인소，병근거Fisher분급계통，분석불동치료방식대SDHC적영향。결과 SDHC발생적위험인소포괄：년령대우등우40세，Hunt-Hess（ H-H）분급Ⅲ、Ⅳ、Ⅴ급，Fisher분급Ⅲ、Ⅳ급，급성뇌적수，뇌실내출혈（ intraventricular hemorrhage， IVH）。 Fisher분급Ⅱ급적환자，전새치료유교저적SDHC발생솔；Fisher분급Ⅳ급적환자，개로협폐치료유교저적SDHC발생솔。결론SDHC적고발생솔여환자적고령、교차적기시신경계통상태、급성뇌적수、뇌실내출혈유관。 Fisher분급Ⅱ급적환자선취전새치료，Ⅳ급적환자선취협폐치료，가명현강저SDHC발생，개선환자예후；Fisher분급Ⅰ、Ⅲ급적환자，량충치료방식대SDHC적발생무영향。
Objective The risk factors for shunt-dependent hydrocephalus ( SDHC ) in aneurysmal subarachnoid hemorrhage (aSAH) patients are discussed and the influence of microsurgical clipping or endovascular coil embolization treatment for SDHC in aSAH patients are compared according to Fisher grading system.Methods A retrospective review was conducted in 768 patients with aSAH who underwent microsurgical clipping or endovascular coiling in our hospital from July 2011 to June 2014.The patients were divided into two groups ( shunt group, 151 patients;non-shunt group, 617 patients ) and risk factors for SDHC were analyzed.The effects of two different treatments for aSAH patients with SDHC according to Fisher grading system were analyzed.Results Independent risk factors for SDHC after aSAH were as follows:≥40 years;Hunt-Hess gradeⅢ, IV or V;Fisher grade III or IV;acute hydrocephalus and intraventricular hemorrhage (IVH).In Fisher gradeⅡpatients, the coiling group showed lower incidence of SDHC, while in Fisher grade IV patients, the clipping group showed lower incidence of SDHC. Conclusion A significant higher rate of SDHC is observed for senior patients with poor initial neurological status, acute hydrocephalus and intraventricular hemorrhage.Fisher gradeⅡpatient prefers endovascular treatment and Fisher grade IV patient prefer microsurgical treatment, which reduce the incidence of SDHC and improve the prognosis of patients.For patients with Fisher gradeⅠandⅢ, there is no significant difference between two different treatments for SDHC.
