DSA阴性蛛网膜下腔出血39例临床分析

DSA negative subarachnoid hemorrhage： a clinical analysis of 39 cases

关键词:  数字减影血管造影  中脑周围非动脉瘤性蛛网膜下腔出血  预后

Key words:  digital subtraction angiography  perimesencephalic nonaneurysmal subarachnoid hemorrhage  prognosis

摘要:

目的探讨全脑数字减影血管造影（digitalsubtractionangiography，DSA）阴性蛛网膜下腔出血（subarachnoidhemorrhage，SAH）中，中脑周围非动脉瘤性蛛网膜下腔出血（perimesencephalicnonaneurysmalsubaractmoidhemorrhage，PNSAH）和非PNSAH的诊断、预后的差异。方法回顾性分析27例PNSAH和12例非PNSAH患者的年龄均值、入院时Hunt-Hess分级、并发症、预后及有无高血压病史等临床资料。结果两组患者平均年龄、高血压病史、入院时Hunt-Hess分级差异均无统计学意义（P＞0.05）；两组患者并发症发生情况差异有统计学意义（Χ²=19.195，P=0.000）；39例患者死亡1例，轻度残疾1例，余37例预后良好。结论非PNSAH患者存在继发并发症后病情变化的可能。建议首次DSA阴性的非PNSAH患者复查DSA，而首次DSA阴性的PNSAH患者选择复查MRA、CTA。

Abstract:

Objective To analyze the clinical features of patients with subarachnoid hemorrhage （SAH） presenting negative digital subtraction angiography （DSA） and the differences of diagnosis and prognosis innegative patients between perimesencephalic nonaneurysmal subarachnoid hemorrhage （PNSAH） and non-PNSAH. Methods Thirty nine DSA-negative SAH patients were enrolled in the study, including 27 patients with perimesencephalic nonaneurysmal subarachnoid hemorrhage （PNSAH） and 12 non-PNSAH patients. The clinical data including mean age, Hunt-Hess grade at admission, complications, prognosis on discharge and history of hypertension were analyzed retrospectively. Results There was no significant difference in mean age, Hunt-Hess grade at admission and history of hypertension between the two groups. The complication rate in non-PNSAHgroup was significantly higher than that in PNSAH （Χ²=19.195, P=0.000）. Except one fatal case and one died, one mild disability case other 37 patients had good prognosis. Conclusion DSA- negative SAH patients with non-PNSAH have risk of condition deteriorated after complications; for them DSA should be repeated; if DSA is still negative, MRA or CTA examination may be followed.