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目的 分析脑血管痉挛(cerebralvasospasm,CVS)高峰期栓塞破裂脑动脉瘤的经验。方法 回顾分析37例在CVS期(破裂后4 ~14d)进行的血管内治疗病例资料,分析其特点。A组14例在脑血管造影上可见CVS;B组23例无CVS。除2例外,余均为破裂第4天起入院。均在治疗后3个月时进行格拉斯哥后果评分(Glasgowoutcomescore, GOS)。结果 A组中有2例因微导管无法通过载瘤动脉而放弃,余12例成功地进行了动脉瘤栓塞和动脉内罂粟碱注射,并有3例行球囊成形术,该12例患者3个月时GOS评分优良7例、中残2例、重残1例、死亡2例。B组患者均成功地接受了栓塞术,GOS优良18例、中残2例、重残2例、死亡1例。结论 CVS期并不都伴发CVS,在CVS期进行血管内治疗并不增加危险,可同时治疗动脉瘤和伴发的CVS,可降低因等待手术而发生的院内再出血和改善CVS患者的预后。
Objective To analyze the experience of embolization and rupture of cerebral aneurysm at the peak of cerebral vasospasm (CVS). Methods Retrospective analysis of 37 cases of CVS (4 ~ 14d after rupture) endovascular treatment of case data, analysis of its characteristics. In group A, CVS was seen on cerebrovascular angiography in 14 cases and no CVS in group B on 23 cases. Except for 2 cases, Yu was admitted to hospital on the 4th day of rupture. The Glasgow Outcomes Scale (GOS) was performed at 3 months after treatment. Results In group A, 2 patients failed to pass the parent artery due to microcatheter and 12 patients successfully underwent aneurysm embolization and intra-arterial injection of papaverine, and 3 patients underwent balloon angioplasty. The 12 patients, 3 Month GOS score excellent in 7 cases, 2 cases of disability, severe disability in 1 case, 2 cases of death. In group B, all the patients underwent embolization successfully. There were 18 cases of GOS, 2 cases of moderate disability, 2 cases of severe disability and 1 case of death. Conclusions CVS is not always associated with CVS. Endovascular treatment during CVS does not increase the risk of concurrent treatment of aneurysms and concomitant CVS. Intra-hospital rebleeding due to awaiting surgery can be reduced and the prognosis of patients with CVS is improved .