蛛网膜下腔出血并颅内血肿疑为动脉瘤破裂的手术探查治疗

摘要

Objective To explore the therapeutic strategies for patients with subarachnoid hemorrhage and intracerebral hematoma suspected as ruptured - aneurysm.Methods The clinical data of 9 patients with above disease from May 2005 to August 2010 in our department were retrospectively analyzed.These cases were all comatose on admission including unilateral pupil dilatation in 5 cases,bilateral pupil dilatation in 3 cases and irregular breathing in 3 cases.All of them underwent emergent surgical exploration within 1 - 2 h after admission.Results 2 cases of anterior communication aneurysm,3 cases of posterior communication aneurysm and 4 cases of middle cerebral aneurysms were found during the exploration.All of the hematomases were cleared and the aneurysms were clipped under microscope.At last,2 patients died,6 ones awakened completely and one was in persistent vegetable state.Conclusion For those critical patients with subarachnoid hemorrhage and intracerebral hematoma suspected ruptured - aneurysm without DSA or CTA examination on admission,it is allowable to perform emergency operation to explore the suspected aneurysm, which can get good therapeutic effects.%目的 探讨自发性蛛网膜下腔出血并颅内血肿疑为动脉瘤破裂的治疗策略.方法 总结2005年5月～2010年8月9例蛛网膜下腔出血并颅内血肿疑为动脉瘤破裂的急诊手术探查治疗,9例入院时均呈昏迷,其中5例一侧瞳孔散大,3例双侧瞳孔散大,3例呼吸不规则;均在入院1～2 h内急诊手术探查.结果 9例中发现前交通动脉瘤2例,后交通动脉瘤3例,大脑中动脉瘤4例,均在显微镜下行血肿清除、动脉瘤夹闭;死亡2例,术后完全清醒6例,植物生存1例.结论 对蛛网膜下腔出血并颅内血肿疑为动脉瘤破裂患者入院时病情危重,未行DSA或CTA检查,为争取抢救时间,可急诊手术探查,效果满意.