蛛网膜下腔出血的诊断、病因和治疗

20021101··vanGijnJ,RinkelGJESAH6/10CTCT6050%1/3SAH109CTCTSAH85%10%5%CT3d10~12SAH3%[1]5%1/4[2]20SAH[3,4][5]130SAH10.5/10[6]CTCT5.6/10[6](1)Olmsted306.9/10[7]SAH50~60[8,9]SAH1.695%CI1.5~2.3[6]2.195%CI1.3~3.6[10]11[5,6,21]n/1095%CI10.5(9.9~11.2)22.0(20.0~23.0)23.0(19.0~28.0)7.8(7.2~8.4)100%CT5.77.1(5.4~8.7)4.5(3.1~5.8)(95%CI)SAH6.6(2.0~21.0)2.8(2.1~3.6)1.9(1.5~2.3)2U/d4.7(2.1~10.5)n/10095%CI51.049.0~53.01.1SAH5%~20%SAH[11]SAH2~6[12-16]SAH[12]SAHSAHvanGijnSubarachnoidhaemorrhage:diagnosis,causesandmanagement.Brain,2001,124(Pt2):249-278.FromDepartmentofNeurology,UniversityMedicalCertreUtrecht,Heidelberglaan100,3584CXUtrecht,TheNetherlands;Email:[e-mail]21009920021101autosomaldominantpolycystickidneydiseaseADPKDSAHSAH2%ADPKD[17]SAHEhlers-DanlosIV1ADPKDSAH[18,19]MarfanSAH129MarfanSAH[20]810SAH23[21]2(1.4295%CI1.12~1.80)[22][21]1.2196032%~67%51%1/3[5]SAH4849(19%95%CI9%~33%)[23]184815(31%95%CI19%~46%)HopJW,RinkelGJE,AlgraA1.5SAHSAH65SAH[2]2SAH2.1SAH1h1/3[24,25][24]SAH101[26]70%43%20%15%[24]SAHSAH17%[27,28]SAH10%[26]SAH90%10%[29]6%~16%SAH[30-32]25SAH1%~2%SAH[33]SAH[34]SAH20021101SAH[35][36]2.2SAHAVM[37]SAH[38,39]AVMSAH[40]SAHSAH[41,42]SAH[43][44][45][46][47]~SAH[48]Horner[49]SAH2.3CTMRISAHCT[50][51]CTSAHSAH[52,53]CT1SAH12hCTCTSAH2%[54]1CTSAHCTSAH20021101[55]SAH[35][56][57,58]FLAIRMRISAHCT[59]MRICT40dMRICT[60,61]MRICT12[62]2.4SAH6h12hCSF[63]CSF()2[64]“”3CSFCSF[63]CTSAH[65]6~12hCSFCTMR5mm3SAH3.1——85%[66-68][69][70,71]2356304668512%15[72]2[73][74,75][73]2[72]n/100(95%CI)0.4(0.4~0.5)3.6(3.1~4.1)3.7(3.0~4.4)6.0(5.3~6.8)200.01(0.00~0.03)20391.3(0.8~2.1)40591.8(1.4~2.2)60802.3(1.9~2.6)802.1(1.5~3.0)2.3(1.7~3.1)95%CI1.3(0.9~2.0)2.3(1.7~3.1)4.0(2.7~6.0)SAH[21]20021101[76,77][78][79][80][81][82][83][84]3.2——SAH31.8%[85]1%~2%[86-88]6h5%[88]MRMRACTCTAMRA[89]SAHMRA169%~100%70%~97%75%~100%[90]SAH4%[91]MRASAH[91-93]CTACTMRA1minMIP2[94]CTAMIP2CTCTACTA85%~98%MRA[90,95,96]CTA[97]80SAHCTA8783%95%CI73%~90%CTA[68]CTA[98,99]CTAMRA20021101[100]83%55%[101]15%[102]3.315%SAH2/310%SAH5%33SAH%CT8510CT5CTCT3.3.1SAH10%2/3[103-108]SAH3[103,109,110][110][112]4[103,113,114][109]CT3::CTA2060~70[115][116]1/3[24,103]20021101[24,103][24][103,116]1/3CT[117]20%CTCSF[118][119][119,120][121,122][120]42.5%~5%[107,109,123]5%95%CT——CTA40CTA16124[124]CTACTA(RuigrokYM,RinkelGJE,BuskensE,VelthuisBKvanGijnJ)3.3.2SAH5[56,125]SAHSAH5%85%10%110SAH5[126][47]Wallenberg[49]30%~70%[49,127-129]SAH[130,131][132-134][135]3.3.3AVMAVMAVM5%6[136]10%~20%AVMWillis[137,138]3.3.4CT7[139,140]AVM20021101[141]5SAH31[142]5SAHCT16SAH200211017SAH3.3.5AVM10%AVMSAH50%20[143,144][145][144,146][147]AVMCT[145]MRIMRA3.3.612[148,149]AVMSAH3.3.71[150]3.3.8“”SAH[151-153]10%[154]CT8CT[155]SAH[151,156][155,157][154,158]8SAH[159]SAH[160]20021101X[160,161]HIV[157-164]HIVSAH[165]3.3.9[166,167][168][166]152[46]CTMRI[46,169]3.3.10crackSAH70%30%~40%[41]CT[170][171][172][171,173]3.3.11SAH1167SAH3[174][175][176]3.3.1230%SAH[177]CTSAH[178]113[177]SAH13.3.13[178-180]95%88%76%311995[180]CSFMRI[179,181,182]3.4SAHCTCT10%[121,122][183-185][186][187-189]CT81772200211013017%[187,189-195]CT23[121,188]1431[192]MRI[62,196]4SAHSAHSAH3CT[197,198]3[197]5HuntHess1968Botterell[199][200]HuntHessNishioka-Botterell[201]GlasgowGlasgowComaScaleGCS[202][203]GCS“”“”1[204]WorldFederationofNeurologicalSurgeonsWFNSGCSGCS14134WFNSSAHGCS12[205]WFNSGCS4WFNSSAH[205]WFNSGlasgow151413141312763[206]5GCSECGX5%3L/d15mg60mg1/4h35200211015.115%[207-209]CT139CT141481h31~24h[210]CT[210]5.230%[52][211]MRACTA[212][213]5.39[214]9SAH5.424h[105,215]24CT1090%1/2[216]5.51131916CT96CT[217][218,219]2002110110SAH11SAHCT615%1432[208]1/31232%1435%~40%[208]461%~2%3%[220]6.120009378[221][222]2090492[223]6.2208010~123d1216200211013d7d3~7d[224][67][225]7~10d[226][227]4~126.3[228][229]19973138348900[230]12563.7%(95%CI,2.7%~4.9%)90%90%22%2%16%[231]300210.8%20.6%32.4%[232]66128%[233]11093[234]71/3SAH12[226]SAHBoston41[235]SAH[116]AVMSAHBoston[236,237][238]Boston[239]SAH[240,241][242]120cm/s200cm/s60%20021101120~200cm/s[243]7.1SAH200/110mmHg(7.5mmHg=1kPa)[244]1963—1970100546[245]CT2080CT[246]SAH[247]7.2SAH1/310%[248,249][250]23L1.5~2.0L[247,251]2230[252]7~102/367%95%CI1%~89%2.5~3.5L4~6L10L8mmHg7mmHg4107.3SAHAT8773SAH[253]AT877AT87720021101SAHAT87760mg1/4h3SAH[254]7.4tirilazad)43500[255-258]216mg/kg·d20.22mg/kg·d[255][256]215mg/kg·d[257,258]2162N'-propylenedinicotinamideSAH3[259]286ebselenSAH3[260]7.5SAH3B2A2[261-263]SAH42420.495%CI0.18~0.93[264]1982[265]5350[266]4SAH320100mg/d10mg/d[267]77A210mg/d[268]24A2cataclot1g/kg·min[269]256OKY-46160800mg[270]42RaupS,HopJW,RinkelGJE,AlgraAvanGijnJ7.63SAH30[252]2[271,272][273]100[274][275]200211017.73H2060SAH[276,277]5843[278]16[279]SAH[280-285]410~2023150[281,286][287][288-290][291]1SudlowCL,WarlowCP.Comparablestudiesoftheincidenceofstrokeanditspathologicaltypes:resultsfromaninternationalcollaboration.InternationalStrokeIncidenceCollaboration.Stroke,1997,28(3):491-499.2JohnstonSC,SelvinS,GressDR.Theburden,trends,anddemographicsofmortalityfromsubarachnoidhemorrhage.Neurology,1998,50(5):1413-1418.3Cush