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題 名 | Acute Hydrocephalus and Chronic Hydrocephalus with the Need of Postoperative Shunting after Aneurysmal Subarachnoid Hemorrhage=動脈瘤破裂引發蜘蛛網膜下腔出血後的急性水腦及慢性水腦需術後腦室腹腔引流 |
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作 者 | 林志隆; 關皚麗; 洪純隆; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷 期 | 15:3 1999.03[民88.03] |
頁 次 | 頁137-145 |
分類號 | 416.291 |
關鍵詞 | 動脈瘤破裂; 蜘蛛網膜下腔出血; 急性水腦; 慢性水腦; 腦室腹腔引流; Subarachnoid hemorrhage; Hydrocephalus; VP shunt; |
語 文 | 英文(English) |
中文摘要 | 我們追蹤 6 年間 168 位蜘蛛網膜下腔出血接受動脈瘤手術的病人,追蹤時間從 6 個月到 77 個月(平均 38 個月)。急性水腦定義為出血後 72 小時內 bicaudate index大於同年齡層的百分之九十五以上。共有 40 位病人(24%)發現有急性水腦。入院時的 Hunt and Hess、Fisher 等級、腦室內出血、有症狀的血管痙攣及腦脊髓液引流都與急性水腦有有意義的相關。 追蹤時的總體死亡率為 16%。存活下來的 141 位病人,20 位(14%)因慢性水腦需腦室腹腔引流。 我們發現年齡、 急性水腦、入院時的 Hunt and Hess、Fisher 等級及腦脊髓液引流都與慢性水腦需腦室腹腔引流有有意義的相關。 沒有病人在出血後 117 天以後再接受腦室腹腔引流。有急性水腦的病人伴有高死亡率(28%)。40 位有急性水腦的病人,29 位存活下來,其中 10 位需腦室腹腔引流。但無急性水腦的病人小於 10%需腦室腹腔引流。 我們建議追蹤蜘蛛網膜下腔出血接受動脈瘤手術的病人至少 6 個月,尤其是有發生慢性水腦高危險群的病人。針對有發生急性水腦高危險群的病人,要密切觀察,盡早診斷,積極治療以減低其高死亡率。 |
英文摘要 | During a 6-year period, 168 consecutive patients who presented with subarachnoid hemorrhage (SAH) and underwent surgical clipping of aneurysms were reviewed at a follow-up examination from 6 to 77 months (mean 38 months) after the ictus. Acute hydrocephalus was defined when the bicaudate index was greater than the 95th percentile for age on a computed tomographic scan within 72 hours of the hemorrhage. Forty (24%) patients developed acute hydrocephalus. The Hunt and Hess grades and Fisher's SAH grades at the time of admission, the presence of intraventricular hemorrhage and symptomatic cerebral vasospasm, and cerebrospinal fluid (CSF)diversion were found to be significantly associated with acute hydrocephalus. The overall mortality in this study was 16%. Of the 141 surviving patients, 20 (14%) patients underwent ventriculoperitoneal (VP) shunt replacement secondary to chronic hydrocephalus. In the present study, we found that the following factors were significantly related to the need of VP shunting: increasing age, the presence of acute hydrocephalus, preoperative CSF diversion, low admission Hunt and Hess grades, and poor Fisher's SAH grades. No patient was readmitted for shunt replacement at ur hospital later than 117 days after hemorrhage. Acute hydrocephalus was combined with high mortality (28%) at our follow-up review. Ten of 29 (34%) patients with acute hydrocephalus required definite shunt replacement. However, less than 10% of patients without acute hydrocephalus needed shunting postoperatively. We recommend that patients with aneurysmal SAH should be followed up at least 6 months after the hemorrhage, especially in those patients with high risks of developing chronic hydrocephalus. |
本系統中英文摘要資訊取自各篇刊載內容。