老年蛛网膜下腔出血的治疗方法和预后分析

目的:探讨70岁以上老年蛛网膜下腔出血患者的治疗方法和预后。方法:回顾性分析我院2006-2012年收治的49例老年蛛网膜下腔出血患者的临床资料及其预后。结果:49例患者入院时Hunt-Hess分级:Ⅰ级14例,Ⅱ级8例,Ⅲ级6例,Ⅳ级6例,Ⅴ级15例,其中14例采用开颅动脉瘤夹闭术,10例采用血管内介入栓塞术,25例采用内科保守治疗。治疗后6月,根据ADL量表评价预后(ADL≥60分为预后良好):内科保守治疗者仅3例预后良好,手术及栓塞术者17例预后良好。结论:对于老年蛛网膜下腔出血患者而言,影响患者预后的原因主要是出血导致的脑损伤和症状性脑血管痉挛,通过手术或栓塞术积极治疗破裂动脉瘤是预后良好的重要因素。

Analysis of the Treatment and Prognosis of Elderly Patients with Subarachnoid Hemorrhage

Objective： To analyze the treatment and prognosis of patients over 70 years old with subarachnoid hemorrhage （SAH）. Methods： A retrospective research was performed on 49 cases of elderly patients with subarachnoid hemorrhage admitted from June 2006 to June 2012 to analyze the treatment and prognosis of elderly patients with subarachnoid hemorrhage. Results： The Hunt-Hess grade on admission revealed that 14 patients were Grade I, 8 cases of Grade 11,6 cases of Grade 111,6 cases of Grade 1V and 15 cases of Grade V. 14 patients underwent surgical clipping, 10 patients underwent coil embolization, 25 patients received conservative therapy. The overall results evaluated for ADL （activities of daily living） after 6 months were as follows： 3 patients in the conservative group had a favorable outcome （ADL I〉 60）, 17patients in the operative and coil embolization group had favorable outcomes. Conclusion： Unfavorable outcom- es were caused mainly by primary brain damage and symptomatic vasospasm in elderly SAH patients, radical treatment of ruptured aneurysm by surgical clipping or coil embolization was important to achieve a favorable outcome.