• 四川大學(xué)華西醫(yī)院神經(jīng)外科（成都，610041）;

顱內(nèi)動脈瘤破裂導(dǎo)致的蛛網(wǎng)膜下腔出血是神經(jīng)外科常見的急癥之一。近年來，隨著開顱顯微手術(shù)及血管內(nèi)介入治療的發(fā)展，對顱內(nèi)動脈瘤的處理有了很大進(jìn)步，但是再破裂出血仍是其最嚴(yán)重的并發(fā)癥，有很高的發(fā)生率及死亡率。本研究就顱內(nèi)動脈瘤再破裂出血的臨床表現(xiàn)、相關(guān)危險因素、防治等方面內(nèi)容進(jìn)行回顧、總結(jié)及展望，為臨床實踐提供建議。

引用本文： 伍聰,賀民,游潮. 顱內(nèi)動脈瘤再破裂風(fēng)險評估和防治方法. 華西醫(yī)學(xué), 2012, 27(12): 1906-1909. doi: 復(fù)制

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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, 趙繼宗, 齊巍, 等. 動脈瘤病人住院期間再出血死亡相關(guān)因素分析[J]. 中華神經(jīng)外科雜志, 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. 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. 2. 　李京生, 趙繼宗, 齊巍, 等. 動脈瘤病人住院期間再出血死亡相關(guān)因素分析[J]. 中華神經(jīng)外科雜志, 2001, 17(2): 81-83.
  3. 3. 　Wartenberg KE, Mayer SA. Subarachnoid hemorrhage[M]// Torbey MT, Selim MH. The stroke book. New York: Cambridge University Press, 2007: 216-221.
  4. 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. 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. 6. 　Kassell NF, Torner JC. Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study[J]. Neurosurgery, 1983, 13(5): 479-481.
  7. 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. 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. 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. 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. 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. 12. 　Paré L, Delfino R, Leblanc R. The relationship of ventricular drainage to aneurysmal rebleeding[J]. J Neurosurg, 1992, 76(3): 422-427.
  13. 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. 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. 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. 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. 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. 18. 　Stornelli SA, French JD. Subarachnoid hemorrhage:factors in prognosis and management[J]. J Neurosurg, 1964, 21: 769-780.
  19. 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. 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. 21. 　Kk UK, Jacobsen CD, Hoak JC. Plasminogen in normal and abnormal human cerebrospinal fluid[J]. Arch Neurol, 1973, 28: 64-66.
  22. 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. 23. 　Pael MK, Clarke MA. Lumbar puncture and subarachnoid heamorrhage[J]. Postgrad Med J, 1986, 63: 1021-1024.
  24. 24. 　Duffy GP. Lumbar puncture spontaneous subarachnoid heamorrhage[J]. BMJ, 1983, 285: 1163-1164.
  25. 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. 26. 　Komiyama M, Tamura K, Nagata Y, et al. Aneurysmal rupture during angiography[J]. Neurosurgery, 1993, 33(5): 798-803.
  27. 27. 　Inagawa T. Timing of admission and management outcome in patients with subarachnoid hemorrhage[J]. Surg Neurol, 1994, 41(4): 268-276.
  28. 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. 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. 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. 31. 　Mullan S, Dawley J. Antifibrinolytic therapy for intracranial aneurysms[J]. J Neurosurg, 1968, 28(1): 21-23.
  32. 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. 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. 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. 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. 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. 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. 38. 　Le Roux P, Winn HR. The poor grade aneurysm patient[J]. Acta Neurochir Suppl, 1999, 72: 7-26.
  39. 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.