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目的探讨非动脉瘤性与动脉瘤性蛛网膜下腔出血(aSAH)的临床特点。方法回顾性分析168例非aSAH和104例aSAH患者入院时的Hunt-Hess分级、CT检查(以德国Freiburg大学神经中心的标准,根据头部CT影像分型)、第1次全脑DSA检查、重复全脑DSA及短期和长期预后MRS(Modified Rankin Scale)评分等临床资料。结果①两组患者入院时的Hunt-Hess分级比较,差异有统计学意义,χ2=74.023,P<0.001。②两组CT分型比较差异有统计学意义,χ2=117.486,P<0.001。非aSAH和aSAH患者伴有脑室积血者分别为36.6%(41/112)和89.4%(93/104),χ2=72.254,P<0.001;脑积水分别为34.8%(39/112)和74.0%(77/104),χ2=38.910,P<0.001。③中脑周围型蛛网膜下腔出血和非中脑周围型蛛网膜下腔出血患者入院时,Hunt-Hess分级比较差异有统计学意义,χ2=16.680,P<0.01;经Spearman相关分析:入院时Hunt-Hess分级与CT分型之间无直线相关关系,r=-0.4,P>0.05。④中脑周围型蛛网膜下腔出血患者脑积水和脑血管痉挛的发生率,分别为14.5%(8/55)和21.8%(12/55),非中脑周围型蛛网膜下腔出血患者脑积水和脑血管痉挛的发生率,分别为54.4%(31/57)和42.1%(24/57),两组比较,χ2=19.575,P<0.01和χ2=5.283,P<0.05。⑤168例非aSAH患者随访92例,MRS≤2分者占90.2%,中、重度残疾占3.3%;104例aSAH患者随访88例,MRS评分≤2分者占50.0%,中、重度残疾占34.1%,χ2=8.42,P<0.05。结论非aSAH比aSAH患者入院时Hunt-Hess分级低,并发症少、预后好,在中脑周围型蛛网膜下腔出血的患者中表现得更加明显。
Objective To investigate the clinical features of non-aneurysmal and aneurysmal subarachnoid hemorrhage (aSAH). Methods The Hunt-Hess grade of 168 non-aSAH patients and 104 aSAH patients were retrospectively analyzed. The CT examination (based on the neurological center of Freiburg University in Germany based on the CT images of the head), the first DSA of whole brain, Repeat whole brain DSA and short-term and long-term prognosis MRS (Modified Rankin Scale) score and other clinical data. Results ① There was significant difference in Hunt-Hess grade in admission between the two groups (χ2 = 74.023, P <0.001). ② There was significant difference in CT classification between the two groups (χ2 = 117.486, P <0.001). 36.6% (41/112) and 89.4% (93/104) of patients with non-aSAH and aSAH, respectively, χ2 = 72.254, P <0.001; and hydrocephalus were 34.8% (39/112) and 74.0% (77/104), χ2 = 38.910, P <0.001. (3) Hunt-Hess grading was significantly different in patients with mesencephalic peripheral subarachnoid hemorrhage and non-mesencephalic peripheral subarachnoid hemorrhage at admission (χ2 = 16.680, P <0.01). After Spearman correlation analysis, admission There was no linear correlation between Hunt-Hess classification and CT classification, r = -0.4, P> 0.05. ④ The incidences of hydrocephalus and cerebral vasospasm in patients with mesencephalon peripheral subarachnoid hemorrhage were 14.5% (8/55) and 21.8% (12/55), respectively. Non-mesencephalic peripheral subarachnoid hemorrhage The incidences of hydrocephalus and cerebral vasospasm in patients were 54.4% (31/57) and 42.1% (24/57), respectively. The two groups were χ2 = 19.575, P <0.01 and χ2 = 5.283, P <0.05. ⑤168 non-aSAH patients were followed up for 92 cases, MRS≤2 points accounted for 90.2%, moderate and severe disabilities accounted for 3.3%; 104 cases of aSAH patients were followed up 88 cases, MRS score ≤ 2 points accounted for 50.0%, moderate and severe disabilities accounted for 34.1 %, χ2 = 8.42, P <0.05. Conclusions Hunt-Hess has a lower grade, fewer complications and a better prognosis than non-aSAH patients on admission, and is more obvious in patients with peripheral mesencephalic subarachnoid hemorrhage.