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目的:探讨老年人自发性蛛网膜下腔出血的治疗方法选择与预后的关系。方法:选择本院1993—06～1999—06收治的60岁以上老年人自发性蛛网膜下腔出血共64例,男26例,女38例,均行头颅CT证实蛛网膜下腔出血(不合并脑内血肿);腰穿呈血性脑脊液,40例行DSA检查,动脉瘤31例,其中后交通动脉瘤14例,颈内动脉床突上段动脉瘤7例,前交通动脉瘤6例,大脑前动脉瘤1例,右小脑后下动脉瘤1例,左大脑中动脉水平段分叉动脉瘤1例,基底动脉分叉部动脉瘤1例;动静脉畸形5例,其中右顶脑动静脉畸形2例,右基底节动静脉畸形1例,小脑动静脉畸形2例;Moyamoya病1例;动脉硬化3例。内科保守治疗29例,血管内治疗25例,手术夹闭及切除病灶10例。结果:内科保守治疗组死亡8例,死亡率27.6％,血管内治疗死亡2例,死亡率8％,手术夹闭及切除病灶组死亡1例,死亡率10％。结论:老年人自发性蛛网膜下腔出血以动脉瘤常见,传统的内科保守治疗死亡率高,血管内治疗或手术是治疗老年人自发性蛛网膜下腔出血有效的治疗方法。
Objective: To explore the relationship between the treatment options and prognosis of spontaneous subarachnoid hemorrhage in the elderly. Methods: A total of 64 cases of spontaneous subarachnoid hemorrhage, including 26 males and 38 females, were enrolled in our hospital from 1993-06 to 1999-06. All patients underwent cranial CT to confirm subarachnoid hemorrhage Merger intracerebral hematoma); lumbar perfusion was bloody cerebrospinal fluid, 40 cases underwent DSA examination, 31 cases of aneurysms, including 14 cases of posterior communicating aneurysm, 7 cases of internal carotid artery anterior segment of the bed, 6 cases of anterior communicating artery aneurysm, 1 case of anterior aneurysm, 1 case of posterior inferior cerebellar artery, 1 case of bifurcation aneurysm in the left middle cerebral artery and 1 case of basilar bifurcation aneurysm. 5 cases of arteriovenous malformation, 2 cases of deformity, 1 case of right basal ganglia arteriovenous malformation, 2 cases of cerebellar arteriovenous malformation, 1 case of Moyamoya disease and 3 cases of arteriosclerosis. Conservative medical treatment in 29 cases, 25 cases of endovascular treatment, surgical clipping and removal of lesions in 10 cases. Results: In conservative treatment group, 8 cases died, the mortality rate was 27.6%, and 2 cases were treated by endovascular treatment. The mortality rate was 8%. One patient was killed by surgical clipping and removal of the lesion group, and the death rate was 10%. Conclusion: Aneurysm is common in elderly patients with spontaneous subarachnoid hemorrhage. The traditional medical conservative treatment has a high mortality rate. Endovascular treatment or surgery is an effective treatment for spontaneous subarachnoid hemorrhage in the elderly.