蛛网膜下腔出血早期病因学诊断和治疗

目的：对蛛网膜下腔出血患者进行早期病因学诊断并针对病因进行治疗。方法：对23例经临床确诊(病史、体格检查、腰穿和脑CT)的蛛网膜下腔出血患者首先进行诊断性全脑血管造影．明确发病原因(动脉瘤?动静脉畸形?抑或其它?)。由神经内科医生、介入科医生和神经外科医生根据检查结果和病人情况(经济状况、自身条件和认识水平等)进行评估，以决定治疗方案(介入治疗?手术夹闭?抑或内科保守治疗?)。结果：经DSA发现，23例中20例有脑动脉瘤，2例为多发；共计22个动脉瘤，18个动脉瘤位于Wills环(占81．8％)，7个位于前交通动脉(31．8％)，11个位于后交通动脉(50％)，多发动脉瘤2例(8％)。10例行手术治疗，6例行介入治疗，7例内科保守治疗，除2例死亡外，21例均痊愈。结论：颅内动脉瘤是SAH的最常见原因，动脉瘤多位于前、后交通动脉，常为单发的中小动脉瘤。手术或介入栓塞治疗，疗效确切。

Early etiology diagnosis and treatment in subarachnoid hemorrhage

Objective:To diagnose in early etiology and treat aimed at pathogeny in patients with subarachnoid hemorrhage.Methods:23 patients with subarachnoid hemorrhage by clinic diagnosis(medical record,medical examiation,lumbar puncture and CT)were performed diagnostic panangiography first to definitude pathogeny(aneurism?arteriovenous malformation?or other?).Then,we evaluate and choose Rx(intervening therapy?surgical treatment?or conservative?) by neurologist and intervention doctors and neurosurgeon according to the examination results and patient status(economic status,physical quality and cognitive level etc.).Results: DSA showed 20 out of 23 suffered from aneurysms (2 from multiple aneurys m).Out of the 22 aneurysms 18(81.8%) were seen in the Willis circle and 7(31.8%) in the anterior communicating artery (ACA) and 11(50%) in the posterior communicating artery(PCA).10 cases received surgical treatment,6 got intervening therapy and 7 was treated conservatively.2 cases died of subarachnoid rehemorrhage.Conclusion:The cerebral aneurysms are the most common causes for SAH. Aneurysms often lie ACA and PCA and especially the small and simple ones.Surgical and intervening treatment are effective.