郭堂军;施恒亮;张桐;解哨;

• 1:徐州医科大学附属医院

摘要(Abstract)：

目的分析动脉瘤破裂致自发性蛛网膜下腔出血患者继发脑积水的危险因素,探讨其临床症状、治疗方法及预后。方法选取徐州医科大学附属医院神经外科2017-01—2019-12入院的动脉瘤破裂性蛛网膜下腔出血患者153例,对其中继发脑积水的38例患者临床资料进行回顾性分析,探讨其继发脑积水的危险因素。结果可能影响动脉瘤破裂性蛛网膜下腔出血患者继发脑积水的危险因素主要有Fisher分级、Hunt-Hess分级、动脉瘤出血部位、出血次数、术中引流方式等。38例患者通过分别实施脑室钻孔外引流、脑室腹腔分流术等治疗,经格拉斯哥预后评分(GOS):痊愈良好20例,轻度残疾13例,重度残疾3例,植物生存2例。结论对于动脉瘤性蛛网膜下腔出血,外科夹闭术中适当地引流、及时地清除积血、术后持续的脑脊液引流有利于降低术后继发脑积水的风险,提高临床治疗效果及患者生存质量。

关键词(KeyWords)： 自发性蛛网膜下腔出血;脑积水;危险因素;动脉瘤;GOS预后评分

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金面上项目(编号:81874081)

作者(Authors): 郭堂军;施恒亮;张桐;解哨;

参考文献(References)：

• [1] D'SOUZA S.Aneurysmal Subarachnoid Hemorrhage[J].J Neurosurg Anesthesiol,2015,27(3):222-240.DOI:10.1097/ANA.0000000000000130.
• [2] PETRIDIS A K,KAMP M A,CORNELIUS J F,et al.Aneurysmal Subarachnoid Hemorrhage[J].Dtsch Arztebl Int,2017,114(13):226-236.DOI:10.3238/arztebl.2017.0226.
• [3] CHIANG Y C,LEE C H,CHEN W H,et al.Acute Paraplegia After Aneurysmal SAH:A Case Report of a Rare Complication and Review of the Literature[J].World Neurosurg,2016,88:695.e11-695.e14.DOI:10.1016/j.wneu.2015.12.070.
• [4] XU H.New concept of the pathogenesis and therapeutic orientation of acquired communicating hydrocephalus[J].Neurol Sci,2016,37(9):1387-1391.DOI:10.1007/s10072-016-2589-7.
• [5] HALL A,O'KANE R.The Extracranial Consequences of Subarachnoid Hemorrhage[J].World Neurosurg,2018,109:381-392.DOI:10.1016/j.wneu.2017.10.016.
• [6] SAJANTI J,BJ?RKSTRAND A S,FINNIL? S,et al.Increase of collagen synthesis and deposition in the arachnoid and the dura following subarachnoid hemorrhage in the rat[J].Biochim Biophys Acta,1999,1454(3):209-216.DOI:10.1016/s0925-4439(99)00016-2.
• [7] AKHONDI H,BAROCHIA S,HOLMSTR?M B,et al.Hydrocephalus as a presenting manifestation of neurosarcoidosis[J].South Med J,2003,96(4):403-406.DOI:10.1097/01.SMJ.0000056648.43258.C0.
• [8] REKATE H L.A consensus on the classification of hydrocephalus:its utility in the assessment of abnormalities of cerebrospinal fluid dynamics[J].Childs Nerv Syst,2011,27(10):1535-1541.DOI:10.1007/s00381-011-1558-y.
• [9] GOULAY R,FLAMENT J,GAUBERTI M,et al.Subarachnoid Hemorrhage Severely Impairs Brain Parenchymal Cerebrospinal Fluid Circulation in Nonhuman Primate[J].Stroke,2017,48(8):2301-2305.DOI:10.1161/STROKEAHA.117.017014.
• [10] BRINKER T,STOPA E,MORRISON J,et al.A new look at cerebrospinal fluid circulation[J].Fluids Barriers CNS,2014,11:10.DOI:10.1186/2045-8118-11-10.
• [11] CHEN S,LUO J,REIS C,et al.Hydrocephalus after Subarachnoid Hemorrhage:Pathophysiology,Diagnosis,and Treatment[J].Biomed Res Int,2017,2017:8584753.DOI:10.1155/2017/8584753.
• [12] STRAHLE J,GARTON H J,MAHER C O,et al.Mechanisms of hydrocephalus after neonatal and adult intraventricular hemorrhage[J].Transl Stroke Res,2012,3(Suppl 1):25-38.DOI:10.1007/s12975-012-0182-9.
• [13] DORAI Z,HYNAN L S,KOPITNIK T A,et al.Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage[J].Neurosurgery,2003,52(4):763-769;discussion 769-771.
• [14] LORANDON F,SALOMON DU MONT L,PUYRAVEAU M,et al.Scannographic study of risk factors of abdominal aortic aneurysm rupture[J].Ann Vasc Surg,2020 Dec 24:S0890-5096(20)31055-4.DOI:10.1016/j.avsg.2020.11.013.
• [15] OPANCINA V,LUKIC S,JANKOVIC S,et al.Risk factors for cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage[J].Open Med (Wars),2020,15(1):598-604.DOI:10.1515/med-2020-0169.
• [16] WANG J M,CHEN Q X.Risk Factors for Intraprocedural Rerupture during Embolization of Ruptured Intracranial Aneurysms[J].J Korean Med Sci,2020,35(48):e430.DOI:10.3346/jkms.2020.35.e430.
• [17] YA X,ZHANG C,LIU J,et al.Risk Factors for Higher Volume of Hemorrhage in Ruptured Anterior Circulation Intracranial Aneurysms[J].Front Surg,2020,7:587790.DOI:10.3389/fsurg.2020.587790.
• [18] CHEN Y B,WANG Z,ZHOU D,et al.Analysis of prognosis and risk factors of 730 patients with anterior communicating aneurysm[J].Zhonghua Yi Xue Za Zhi,2020,100(44):3515-3519.DOI:10.3760/cma.j.cn112137-20200319-00832.
• [19] HAASE A,SCHOB S,QU?SCHLING U,et al.Epidemiologic and anatomic aspects comparing incidental and ruptured intracranial aneurysms:A single centre experience[J].J Clin Neurosci,2020,81:151-157.DOI:10.1016/j.jocn.2020.09.048.
• [20] BAKKER M K,VAN DER SPEK R A A,VAN RHEENEN W,et al.Genome-wide association study of intracranial aneurysms identifies 17 risk loci and genetic overlap with clinical risk factors[J].Nat Genet,2020,52(12):1303-1313.DOI:10.1038/s41588-020-00725-7.
• [21] SON W,KANG D H.Risk Factor Analysis of Delayed Intracerebral Hemorrhage After Coil Embolization of Unruptured Cerebral Aneurysms[J].Front Neurol,2020,11:584596.DOI:10.3389/fneur.2020.584596.
• [22] WANG H,OU J,GONG W,et al.Morphologic Features of Symptomatic and Ruptured Abdominal Aortic Aneurysm in Asian Patients[J].Ann Vasc Surg,2020 Nov 4:S0890-5096(20)30932-8.DOI:10.1016/j.avsg.2020.09.059.
• [23] YUE J,XIE Y,ZHANG X,et al.The safety and outcomes of acutely ruptured intracranial aneurysms with incomplete occlusion after coiling:a case-control study[J].BMC Neurol,2020,20(1):412.DOI:10.1186/s12883-020-01991-y.
• [24] SIVAKOTI S,CHAVALI P,NANDEESH B N,et al.Distal anterior cerebral artery aneurysm with bilateral fetal posterior cerebral arteries and trifurcation of anterior cerebral artery[J].Indian J Pathol Microbiol,2020,63(4):651-653.DOI:10.4103/IJPM.IJPM_1021_19.
• [25] GARZELLI L,SHOTAR E,BLAUWBLOMME T,et al.Risk Factors for Early Brain AVM Rupture:Cohort Study of Pediatric and Adult Patients[J].AJNR Am J Neuroradiol,2020,41(12):2358-2363.DOI:10.3174/ajnr.A6824.
• [26] ZHANG P,GUAN C,LI C,et al.A visual risk assessment tool for acute kidney injury after intracranial aneurysm clipping surgery[J].Ren Fail,2020,42(1):1093-1099.DOI:10.1080/0886022X.2020.1838299.
• [27] DHARIA A,LACCI J V,MASCITELLI J,et al.Impact of Ruptured Aneurysm Circulation on Mortality:A Nationwide Inpatient Sample Analysis[J].J Stroke Cerebrovasc Dis,2020,29(10):105124.DOI:10.1016/j.jstrokecerebrovasdis.2020.105124.
• [28] YU H,ZHAN R,WEN L,et al.The relationship between risk factors and prognostic factors in patients with shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage[J].J Craniofac Surg,2014,25(3):902-906.DOI:10.1097/SCS.000000000000 0561.
• [29] DEGOS V,GOURRAUD PA,TURSIS V T,et al.Elderly age as a prognostic marker of 1-year poor outcome for subarachnoid hemorrhage patients through its interaction with admission hydrocephalus[J].Anesthesiology,2012,117(6):1289-1299.DOI:10.1097/ALN.0b013e318267395b.
• [30] YOSHIOKA H,INAGAWA T,TOKUDA Y,et al.Chronic hydrocephalus in elderly patients following subarachnoid hemorrhage[J].Surg Neurol,2000,53(2):119-124;discussion 124-125.DOI:10.1016/s0090-3019(99)00185-8.
• [31] CHEN Q,FENG Z,TAN Q,et al.Post-hemorrhagic hydrocephalus:Recent advances and new therapeutic insights[J].J Neurol Sci,2017,375:220-230.DOI:10.1016/j.jns.2017.01.072.
• [32] KARAMANAKOS P N,VON UND ZU FRAUNBERG M,BENDEL S,et al.Risk factors for three phases of 12-month mortality in 1657 patients from a defined population after acute aneurysmal subarachnoid hemorrhage[J].World Neurosurgery,2012,78(6):631-639.DOI:10.1016/j.wneu.2011.08.033.
• [33] ZHANG M S,ZHANG H W,GU C Y,et al.Strategy of the diagnosis and treatment for hydrocephalus associated with acoustic neuroma[J].Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi,2016,51(6):419-422.DOI:10.3760/cma.j.issn.1673-0860.2016.06.004.
• [34] SUMMERS L E,GUTIERREZ C M,WALSH J W,et al.Hydrocephalus[J].J La State Med Soc,2002,154(1):40-43.
• [35] ARSLAN M,AYCAN A,GULSEN I,et al.Relationship between hydrocephalus etiology and ventriculoperitoneal shunt infection in children and review of literature[J].J Pak Med Assoc,2018,68(1):38-41.
• [36] UCHE E O,OKORIE C,ILOABACHIE I,et al.Endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in non-communicating hydrocephalus (NCH):comparison of outcome profiles in Nigerian children[J].Childs Nerv Syst,2018,34(9):1683-1689.DOI:10.1007/s00381-018-3848-0.