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目的探讨蛛网膜下腔出血(subarachnoid hemorrhage,SAH)患者首次数字减影血管造影(digital subtractionangiography,DSA)呈阴性的原因及诊疗策略。方法对近年来44例首次DSA呈阴性的SAH病人的临床资料进行回顾性分析,并在出血后2～3周进行DSA复查,分析其阴性结果及原因。结果 DSA阴性组在性别、年龄、Hunt-Hess分级及Fish-er分级、高血压诱因与DSA阳性组比较差异均有统计学意义(P<0.05);对首次DSA阴性患者2～3周后行DSA复查,6例诊断为动脉瘤或血管畸形,脑周围非动脉瘤性蛛网膜下腔出血(PNSAH)患者14例中,复查DSA亦无阳性发现,20例患者原因不明。结论对首次DSA检查结果呈阴性的SAH病人,中脑周围非动脉瘤性蛛网膜下腔出血临床过程及预后相对良性,可不必重复造影。其余患者均应在2～3周后行DSA或CTA、MRA复查,甚至手术探查,预后相对于动脉瘤性蛛网膜下腔出血亦良好。
Objective To investigate the causes of negative digital subtraction angiography (DSA) in patients with subarachnoid hemorrhage (SAH) and the diagnosis and treatment strategies. Methods The clinical data of 44 SAH patients who were negative for the first time in DSA were retrospectively analyzed. DSA was performed at 2 to 3 weeks after hemorrhage. The negative results and their causes were analyzed. Results There were significant differences in gender, age, Hunt-Hess grade, Fish-er classification, hypertension predisposing factor and DSA-positive group between DSA negative group and DSA negative group (P <0.05) Of the 14 patients diagnosed as aneurysms or vascular malformations with non-aneurysmal subarachnoid hemorrhage (PNSAH) around the brain, no DSA was found in the retrospective study, and 20 patients were unknown. Conclusions The clinical course and prognosis of non-aneurysmal subarachnoid hemorrhage around midbrain are relatively benign in patients with SAH who are negative for the first DSA test. The remaining patients should be in 2 to 3 weeks after DSA or CTA, MRA review, or even surgical exploration, prognosis relative to aneurysmal subarachnoid hemorrhage is also good.