【摘要】 目的探讨颅内动脉瘤性蛛网膜下腔出血后脑血管痉挛的预防及治疗方法。方法对107例颅内动脉瘤性蛛网膜下腔出血患者的临床资料进行回顾性分析。107例均在出血后早期(72 h内)行介入动脉瘤栓塞术或开颅动脉瘤夹闭术。术后均给予尼莫地平持续泵入扩血管、脑脊液引流、3H疗法等治疗。结果共发生症状性血管痉挛53例，37例恢复良好，13例中重度残疾，3例死亡。104例患者随访3个月未发现再出血。结论尽早行开颅动脉瘤夹闭术或介入动脉瘤栓塞术，术后给予尼莫地平持续泵入、脑脊液引流、3H疗法等是治疗和预防动脉瘤破裂引起的蛛网膜下腔出血后脑血管痉挛的有效方法。
【关键词】 脑血管痉挛; 动脉瘤; 蛛网膜下腔出血
Prevention and Treatment of cerebral vasospasm after aneurysmal subarachnoid
hemorrhage in 107 case
CHENG Xiaojiang, Maimaitili·Mijiti, Maimaijiang·Abulizi, et al
(Department of Neurosurgery, First Affiliated Hospital, Xinjiang Medical University,
Urumqi 830011, China)
Abstract: ObjectiveTo discuss the methods in prevention and treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. MethodsThe clinical records and radiographic images of 107 patients with aneurysmal subarachnoid hemorrhage were retrospectively reviewed. ResultsAll of them were treated by surgical occlusion using aneurysm clips or embolized by microcoil in early period (<72 h). After the operation, all cases were treated with Nimodipine, cerebrospinal fluid drainage and 3H therapy. Cerebral symptomatic vasospasm occurred in 53 patients. Of which, 37 cases were cured well, 13 cases were neurofunctional absence, 3 cases were dead. ConclusionSurgical management or endovascular management in earlier period, then taking the Nimodipine, draining cerebrospinal fluid and using 3H therapy, they are the effective measures for preventing and treating cerebral vasospasm after subarachnoid hemorrhage.
Key words: cerebral vasospasm; aneurysm; subarachnoid hemorrhage
脑血管痉挛(CVS)是指蛛网膜下腔出血(SAH)后脑底的大动脉迟发性狭窄，影像学检查和脑血流图像常可发现，受影响的动脉末梢区域血流灌注减少，是导致动脉瘤性蛛网膜下腔出血后神经功能障碍的主要原因之一。近年来，随着显微神经外科手术和血管内介入治疗技术的发展，对颅内动脉瘤的治疗效果日益满意，但对脑血管痉挛尚无特效疗法，其发生机制也不甚明了。我科2008年1月～2009年1月共收治颅内动脉瘤性蛛网膜下腔出血患者107例，发生症状性脑血管痉挛53例，本文对107例患者的临床资料进行回顾性分析，旨在进一步探讨颅内动脉瘤性蛛网膜下腔出血后脑血管痉挛的预防及治疗方法，现报道如下。
1资料及方法
1.1一般资料本组患者107例，男性4
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