颅内动脉瘤再破裂风险评估和防治方法_West China Medical Journal

Authors：

伍聪 ,  贺民 , 游潮

Corresponding author：

贺民, Email: wu_cong38@yahoo.com.cn

Keywords：

颅内动脉瘤; 蛛网膜下腔出血; 再破裂出血; 危险因素; 预防治疗

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颅内动脉瘤破裂导致的蛛网膜下腔出血是神经外科常见的急症之一。近年来，随着开颅显微手术及血管内介入治疗的发展，对颅内动脉瘤的处理有了很大进步，但是再破裂出血仍是其最严重的并发症，有很高的发生率及死亡率。本研究就颅内动脉瘤再破裂出血的临床表现、相关危险因素、防治等方面内容进行回顾、总结及展望，为临床实践提供建议。

Citation： 伍聪,贺民,游潮. 颅内动脉瘤再破裂风险评估和防治方法. West China Medical Journal, 2012, 27(12): 1906-1909. doi: Copy

1.	Alvord EC Jr, Loeser JD, Bailey WL, et al. Subarachnoid hemorrhage due to ruptured aneurysms. A simple method of estimating prognosis[J]. Acta Neurol, 1972, 27(4): 273-284.
2.	李京生, 赵继宗, 齐巍, 等. 动脉瘤病人住院期间再出血死亡相关因素分析[J]. 中华神经外科杂志, 2001, 17(2): 81-83.
3.	Wartenberg KE, Mayer SA. Subarachnoid hemorrhage[M]// Torbey MT, Selim MH. The stroke book. New York: Cambridge University Press, 2007: 216-221.
4.	Hijdra A, Vermeulen M, van Gijn J, et al. Rerupture of intracranial aneurysms: a clinicoanatomic study[J]. J Neurosurg, 1987, 67(1): 29-33.
5.	Nibbelink DW, Torner JC, Henderson WG. Intracranial aneurysms and subarachnoid hemorrhage. A cooperative study. Antifibrinolytic therapy in recent onset subarachnoid hemorrhage[J]. Stroke, 1975, 6(6): 622-629.
6.	Kassell NF, Torner JC. Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study[J]. Neurosurgery, 1983, 13(5): 479-481.
7.	Brilstra EH, Rinkel GJ, Algra A, et al. Rebleeding, secondary ischemia, and timing of operation in patients with subarachnoid hemorrhage[J]. Neurology, 2000, 55(11): 1656-1660.
8.	Ohkuma H, Tsurutani H, Suzuki S. Incidence and significance of early aneurysmal rebleeding before neurosurgical or neurological management[J]. Stroke, 2001, 32: 1176-1180.
9.	Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2012, 43(6): 1711-1737.
10.	Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms[J]. J Neurosurg, 1968, 28(1): 14-20.
11.	Rosenorn J, Eskesen V, Schmidt K, et al. The risk of rebleeding from ruptured intracranial aneurysms[J]. J Neurosurg, 1987, 67: 329-332.
12.	Paré L, Delfino R, Leblanc R. The relationship of ventricular drainage to aneurysmal rebleeding[J]. J Neurosurg, 1992, 76(3): 422-427.
13.	Hijdra A, van Gijn J, Nagelkerke NJ, et al. Prediction of delayed cerebral ischemia, rebleeding, and outcome after aneurysmal subarachnoid hemorrhage[J]. Stroke, 1988, 19(10): 1250-1256.
14.	Taylor CL, Yuan Z, Selman WR, et al. Cerebral arterial aneurysm formation and rupture in 20,767 elderly patients: hypertension and other risk factors[J]. J Neurosurg, 1995, 83(5): 812-819.
15.	Kubota M, Yamaura A, Ono J. Prevalence of risk factors for aneurysmal subarachnoid haemorrhage: results of a Japanese multicentre case control study for stroke[J]. Br J Neurosurg, 2001, 15(6): 474-478.
16.	Torner JC, Kassell NF, Wallace RB, et al. Preoperative prognostic factors for rebleeding and survival in aneurysm patients receiving antifibrinolytic therapy: report of the Cooperative Aneurysm Study[J]. Neurosurgery, 1981, 9(5): 506-513.
17.	Wijdicks EM, Vermeulen M, Murray GD, et al. The effects of treating hypertension following aneurysmal subarachnoid hemorrhage[J]. Clin Neurol Neurosurg, 1990, 92(2): 111-117.
18.	Stornelli SA, French JD. Subarachnoid hemorrhage:factors in prognosis and management[J]. J Neurosurg, 1964, 21: 769-780.
19.	Naidech AM, Janjua N, Kreiter KT, et al. Predictors and impact of aneurysm rebleeding after subarachnoid hemorrhage[J]. Arch Neurol, 2005, 62(3): 410-416.
20.	Fujii Y, Takeuchi S, Sasaki O, et al. Ultra-early rebleeding in spontaneous subarachnoid hemorrhage[J]. J Neurosurg, 1996, 84(1): 35-42.
21.	Kk UK, Jacobsen CD, Hoak JC. Plasminogen in normal and abnormal human cerebrospinal fluid[J]. Arch Neurol, 1973, 28: 64-66.
22.	Schisano G, Franco A, Nina P, et al. Monitoring of fibrin and fibrinogen degradation products (FDP) in the cerebrospinal fluid of patients with subarachnoid haemorrhage due to ruptured aneurysm. Report of 55 cases[J]. J Neurosurg Sci, 1994, 38(2): 77-86.
23.	Pael MK, Clarke MA. Lumbar puncture and subarachnoid heamorrhage[J]. Postgrad Med J, 1986, 63: 1021-1024.
24.	Duffy GP. Lumbar puncture spontaneous subarachnoid heamorrhage[J]. BMJ, 1983, 285: 1163-1164.
25.	Sampei T, Yasui N, Mizuno M, et al. Contrast medium extravasation during cerebral angiography for ruptured intracranial aneurysm--clinical analysis of 26 cases[J]. Neurol Med Chir (Tokyo), 1990, 30(13): 1011-1015.
26.	Komiyama M, Tamura K, Nagata Y, et al. Aneurysmal rupture during angiography[J]. Neurosurgery, 1993, 33(5): 798-803.
27.	Inagawa T. Timing of admission and management outcome in patients with subarachnoid hemorrhage[J]. Surg Neurol, 1994, 41(4): 268-276.
28.	Wu TC, Tsui YK, Chen TY, et al. Rebleeding of aneurysmal subarachnoid hemorrhage in computed tomography angiography: risk factor, rebleeding pattern, and outcome analysis[J]. J Comput Assist Tomogr, 2012, 36(1): 103-108.
29.	Hasan D, Vermeulen M, Wijdicks EF, et al. Management problems in acute hydrocephalus after subarachnoid hemorrhage[J]. Stroke, 1989, 20(6): 747-753.
30.	Vale FL, Bradley EL, Fisher WS 3rd. The relationship of subarachnoid hemorrhage and the need for postoperative shunting[J]. J Neurosurg, 1997, 86(3): 462-466.
31.	Mullan S, Dawley J. Antifibrinolytic therapy for intracranial aneurysms[J]. J Neurosurg, 1968, 28(1): 21-23.
32.	Nibbelink DW, Sahs AL. Antifibrinolytic therapy and drug induced hypotension in treatment of ruptured intracranial aneurysms[J]. (Preliminary report.)Trans Amer Neurol Assoc, 1972, 97: 145-147.
33.	Vermeulen M, Lindsay KW, Murray GD, et al. Antifibrinolytic treatment in subarachnoid hemorrhage[J]. N Engl J Med, 1984, 311(7): 432-437.
34.	Tsementzis SA, Hitchcock ER, Meyer CH. Benefits and risks of antifibrinolytic therapy in the management of ruptured intracranial aneurysms. A double-blind placebo-controlled study[J]. Acta Neurochir, 1990, 102(1-2): 1-10.
35.	Beck DW, Adams HP, Flamm ES, et al. Combination of aminocaproic acid and nicardipine in treatment of aneurysmal subarachnoid hemorrhage[J]. Stroke, 1988, 19(1): 63-67.
36.	Hillman J, Fridriksson S, Nilsson O, et al. Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachnoid hemorrhage: a prospective randomized study[J]. J Neurosurg, 2002, 97(4): 771-778.
37.	Haley EC Jr, Kassell NF, Torner JC. The international cooperative study on the timing of aneurysm surgery. the North American experience[J]. Stroke, 1992, 23(2): 205-214.
38.	Le Roux P, Winn HR. The poor grade aneurysm patient[J]. Acta Neurochir Suppl, 1999, 72: 7-26.
39.	Lanzino G, Kassell NF, Germanson TP, et al. Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse?[J]. J Neurosurg, 1996, 85(3): 410-418.

1. 　Alvord EC Jr, Loeser JD, Bailey WL, et al. Subarachnoid hemorrhage due to ruptured aneurysms. A simple method of estimating prognosis[J]. Acta Neurol, 1972, 27(4): 273-284.
2. 　李京生, 赵继宗, 齐巍, 等. 动脉瘤病人住院期间再出血死亡相关因素分析[J]. 中华神经外科杂志, 2001, 17(2): 81-83.
3. 　Wartenberg KE, Mayer SA. Subarachnoid hemorrhage[M]// Torbey MT, Selim MH. The stroke book. New York: Cambridge University Press, 2007: 216-221.
4. 　Hijdra A, Vermeulen M, van Gijn J, et al. Rerupture of intracranial aneurysms: a clinicoanatomic study[J]. J Neurosurg, 1987, 67(1): 29-33.
5. 　Nibbelink DW, Torner JC, Henderson WG. Intracranial aneurysms and subarachnoid hemorrhage. A cooperative study. Antifibrinolytic therapy in recent onset subarachnoid hemorrhage[J]. Stroke, 1975, 6(6): 622-629.
6. 　Kassell NF, Torner JC. Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study[J]. Neurosurgery, 1983, 13(5): 479-481.
7. 　Brilstra EH, Rinkel GJ, Algra A, et al. Rebleeding, secondary ischemia, and timing of operation in patients with subarachnoid hemorrhage[J]. Neurology, 2000, 55(11): 1656-1660.
8. 　Ohkuma H, Tsurutani H, Suzuki S. Incidence and significance of early aneurysmal rebleeding before neurosurgical or neurological management[J]. Stroke, 2001, 32: 1176-1180.
9. 　Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2012, 43(6): 1711-1737.
10. 　Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms[J]. J Neurosurg, 1968, 28(1): 14-20.
11. 　Rosenorn J, Eskesen V, Schmidt K, et al. The risk of rebleeding from ruptured intracranial aneurysms[J]. J Neurosurg, 1987, 67: 329-332.
12. 　Paré L, Delfino R, Leblanc R. The relationship of ventricular drainage to aneurysmal rebleeding[J]. J Neurosurg, 1992, 76(3): 422-427.
13. 　Hijdra A, van Gijn J, Nagelkerke NJ, et al. Prediction of delayed cerebral ischemia, rebleeding, and outcome after aneurysmal subarachnoid hemorrhage[J]. Stroke, 1988, 19(10): 1250-1256.
14. 　Taylor CL, Yuan Z, Selman WR, et al. Cerebral arterial aneurysm formation and rupture in 20,767 elderly patients: hypertension and other risk factors[J]. J Neurosurg, 1995, 83(5): 812-819.
15. 　Kubota M, Yamaura A, Ono J. Prevalence of risk factors for aneurysmal subarachnoid haemorrhage: results of a Japanese multicentre case control study for stroke[J]. Br J Neurosurg, 2001, 15(6): 474-478.
16. 　Torner JC, Kassell NF, Wallace RB, et al. Preoperative prognostic factors for rebleeding and survival in aneurysm patients receiving antifibrinolytic therapy: report of the Cooperative Aneurysm Study[J]. Neurosurgery, 1981, 9(5): 506-513.
17. 　Wijdicks EM, Vermeulen M, Murray GD, et al. The effects of treating hypertension following aneurysmal subarachnoid hemorrhage[J]. Clin Neurol Neurosurg, 1990, 92(2): 111-117.
18. 　Stornelli SA, French JD. Subarachnoid hemorrhage:factors in prognosis and management[J]. J Neurosurg, 1964, 21: 769-780.
19. 　Naidech AM, Janjua N, Kreiter KT, et al. Predictors and impact of aneurysm rebleeding after subarachnoid hemorrhage[J]. Arch Neurol, 2005, 62(3): 410-416.
20. 　Fujii Y, Takeuchi S, Sasaki O, et al. Ultra-early rebleeding in spontaneous subarachnoid hemorrhage[J]. J Neurosurg, 1996, 84(1): 35-42.
21. 　Kk UK, Jacobsen CD, Hoak JC. Plasminogen in normal and abnormal human cerebrospinal fluid[J]. Arch Neurol, 1973, 28: 64-66.
22. 　Schisano G, Franco A, Nina P, et al. Monitoring of fibrin and fibrinogen degradation products (FDP) in the cerebrospinal fluid of patients with subarachnoid haemorrhage due to ruptured aneurysm. Report of 55 cases[J]. J Neurosurg Sci, 1994, 38(2): 77-86.
23. 　Pael MK, Clarke MA. Lumbar puncture and subarachnoid heamorrhage[J]. Postgrad Med J, 1986, 63: 1021-1024.
24. 　Duffy GP. Lumbar puncture spontaneous subarachnoid heamorrhage[J]. BMJ, 1983, 285: 1163-1164.
25. 　Sampei T, Yasui N, Mizuno M, et al. Contrast medium extravasation during cerebral angiography for ruptured intracranial aneurysm--clinical analysis of 26 cases[J]. Neurol Med Chir (Tokyo), 1990, 30(13): 1011-1015.
26. 　Komiyama M, Tamura K, Nagata Y, et al. Aneurysmal rupture during angiography[J]. Neurosurgery, 1993, 33(5): 798-803.
27. 　Inagawa T. Timing of admission and management outcome in patients with subarachnoid hemorrhage[J]. Surg Neurol, 1994, 41(4): 268-276.
28. 　Wu TC, Tsui YK, Chen TY, et al. Rebleeding of aneurysmal subarachnoid hemorrhage in computed tomography angiography: risk factor, rebleeding pattern, and outcome analysis[J]. J Comput Assist Tomogr, 2012, 36(1): 103-108.
29. 　Hasan D, Vermeulen M, Wijdicks EF, et al. Management problems in acute hydrocephalus after subarachnoid hemorrhage[J]. Stroke, 1989, 20(6): 747-753.
30. 　Vale FL, Bradley EL, Fisher WS 3rd. The relationship of subarachnoid hemorrhage and the need for postoperative shunting[J]. J Neurosurg, 1997, 86(3): 462-466.
31. 　Mullan S, Dawley J. Antifibrinolytic therapy for intracranial aneurysms[J]. J Neurosurg, 1968, 28(1): 21-23.
32. 　Nibbelink DW, Sahs AL. Antifibrinolytic therapy and drug induced hypotension in treatment of ruptured intracranial aneurysms[J]. (Preliminary report.)Trans Amer Neurol Assoc, 1972, 97: 145-147.
33. 　Vermeulen M, Lindsay KW, Murray GD, et al. Antifibrinolytic treatment in subarachnoid hemorrhage[J]. N Engl J Med, 1984, 311(7): 432-437.
34. 　Tsementzis SA, Hitchcock ER, Meyer CH. Benefits and risks of antifibrinolytic therapy in the management of ruptured intracranial aneurysms. A double-blind placebo-controlled study[J]. Acta Neurochir, 1990, 102(1-2): 1-10.
35. 　Beck DW, Adams HP, Flamm ES, et al. Combination of aminocaproic acid and nicardipine in treatment of aneurysmal subarachnoid hemorrhage[J]. Stroke, 1988, 19(1): 63-67.
36. 　Hillman J, Fridriksson S, Nilsson O, et al. Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachnoid hemorrhage: a prospective randomized study[J]. J Neurosurg, 2002, 97(4): 771-778.
37. 　Haley EC Jr, Kassell NF, Torner JC. The international cooperative study on the timing of aneurysm surgery. the North American experience[J]. Stroke, 1992, 23(2): 205-214.
38. 　Le Roux P, Winn HR. The poor grade aneurysm patient[J]. Acta Neurochir Suppl, 1999, 72: 7-26.
39. 　Lanzino G, Kassell NF, Germanson TP, et al. Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse?[J]. J Neurosurg, 1996, 85(3): 410-418.

West China Medical Journal

颅内动脉瘤再破裂风险评估和防治方法

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