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題名 | Management of Aneurysmal Subarachnoid Hemorrhage=動脈瘤破裂引發蜘蛛網膜下腔出血的治療 |
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作者 | 黃祖源; 林志隆; 洪純隆; | 書刊名 | 中華民國重症醫學雜誌 |
卷期 | 4:2 2002.04[民91.04] |
頁次 | 頁95-100 |
分類號 | 416.29 |
關鍵詞 | 動脈瘤; 蜘蛛網膜下腔出血; 血管痙攣; 治療; Aneurysm; Subarachnoid hemorrhage; Vasospasm; Management; |
語文 | 英文(English) |
中文摘要 | 雖然過去三十年治療與顯微手術技術的進步,動脈瘤破裂引發蜘蛛膜下腔出血仍伴隨極高的罹病率與死亡率。本研究的目的為是供我們治療此類病人的經驗,來分析其臨床表徵,治療及預後。 在七年間共有178位病人(66位男性,112位女性)接受動脈瘤手術,這些病人術後追蹤1至82個月(平均39個月),病人年紀從29歲至88歲(平均53.2歲),入院時昏迷指數15分者有64%,12至14分者有17%,8至11分者有8%,6至7分都有6%,3至5分者有5%。 以Fisher’s grade分級,30%為第一及第二級。60%的病人有高血壓病史。最常見部份的前交通動脈(30%),其次為內頸-後交通動脈。早期開刀(出血後三天內)占23%。有徵狀的腦血管痙攣發生在26%的病人,13%的病人在電腦斷層上發現低密度區。19%的病人有急性水腦,16%的病人需做腦室腹腔引流。癲癇發生在17%的病人。其預後以Glasgow Outcome Scale評量,53%的病人恢復至第1級,但有13%病人死亡。 針對動能破裂的高羅病率及死亡率,需積極去做正確、快速的診斷。要改善其預後,有經驗的內外科治療是必要的。 |
英文摘要 | Object: in spite of the evolution of management paradigms and microsurgical techniques witnessed over the last 30 years, aneurismal subarachnoid hemorrhage (SAH) is still associated with high morbidity and mortality. The aim of this study was to combine our experience to analyze the clinical findings, treatment, and outcomes in 178 patients undergoing aneurysm surgery. Methods: During a 7-year period, 178 consecutive patients (66 males and 112 females) who had undergone aneurysm surgery were reviewer at the follow-up examination from 1 to 82 months (mean 39 months) after operation. Results: Of the 178 patients who were reviewed, the age ranges from 29 to 88, with an average of 53.2 years. On admission, 64% of cases had Glasgow Coma Scale (GCS) 15, 17% had 12-14, 8% had 8-11, 6% had 6-7, and 5% had 3-5. The degree of SAH was determined by Fisher’s grade. Fifty-three (30%) patients were classified in grades Ⅰ and Ⅱ. Sixty percent of cases had pre-existing hypertension. The most common location of aneurysms was the anterior communicating artery (44%0, followed by the internal carotid-posterior communicating artery (30%). Early operation (within the first three days after the bleeding) was performed in 23% of cases. Symptomatic cerebral vasospasm was diagnosed in 46 (26%) cases, but only 23 (13%) had evidence of low density on the computerized tomography scan. Acute hydrocephalus developed in 34 (19%) cases and 29 (16%0 needed ventriculoperitoneal shunting. Seizure developed in 30 (17%) patients. The outcome was determined using the Glasgow Outcome Scale (GOS). Fifty-three percent of the patients made a good recovery to GOS I and 13% died. Conclusion: The high mortality and morbidity of aneurysm rupture justify an aggressive attempt to establish a prompt and accurate diagnosis. Expert medical and surgical interventions are mandatory to improve the prognosis. |
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