Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan.
World Neurosurg. 2010 Feb;73(2):84-92; discussion e11. doi: 10.1016/j.surneu.2009.07.001. Epub 2009 Oct 13.
A community-based study was conducted to evaluate the factors related to the size of ruptured aneurysms and the effects of aneurysm size on clinical features.
Data from 358 patients with subarachnoid hemorrhage (SAH) treated between 1980 and 1998 in Izumo, Japan, were reviewed. In 285 of these patients, the sizes of the ruptured aneurysms were determined.
Aneurysm diameter was less than 5 mm in 68 patients, at least 5 to less than 10 mm in 137 patients, and 10 mm or more in 80 patients. Aneurysm size tended to increase with patient age. Age (≥60 years of age) and cigarette smoking were independently associated with aneurysms of 5 mm or more in diameter. Multiple aneurysms were positively and anterior cerebral artery aneurysms were inversely related to aneurysms of 10 mm or more in diameter. The larger the aneurysm, the worse was the World Federation of Neurosurgical Societies grade. The risk of rebleeding was higher in patients with larger (≥10 mm) aneurysms than in those with smaller (<10 mm) aneurysms. The incidences of diffuse severe SAH on computed tomographic scans in patients with SAH alone, symptomatic vasospasm, and hydrocephalus were higher in patients with larger (≥5 mm) aneurysms than in those with smaller (<5 mm) aneurysms. The larger the aneurysm, the worse was either functional outcome or the 6-month and 2-year survival rates.
Age, cigarette smoking, multiple aneurysms, and aneurysm site appear to be related to the size of ruptured aneurysms. Patients with larger aneurysms seem to have a worse clinical condition and more severe SAH, resulting in higher incidences of rebleeding, symptomatic vasospasm and hydrocephalus, and a worse outcome.
本研究通过社区调查，旨在评估与破裂动脉瘤大小相关的因素，以及动脉瘤大小对临床特征的影响。
回顾分析日本出云市 1980 年至 1998 年间收治的 358 例蛛网膜下腔出血（SAH）患者的资料，其中 285 例患者的破裂动脉瘤大小可确定。
动脉瘤直径<5mm 者 68 例，≥5mm 且<10mm 者 137 例，≥10mm 者 80 例。患者年龄越大，动脉瘤直径越大。年龄（≥60 岁）和吸烟史与直径≥5mm 的动脉瘤独立相关。多发动脉瘤与直径≥10mm 的动脉瘤呈正相关，大脑前动脉动脉瘤与直径≥10mm 的动脉瘤呈负相关。动脉瘤越大，世界神经外科学会分级越差。较大（≥10mm）动脉瘤患者再出血风险高于较小（<10mm）动脉瘤患者。单纯 SAH 患者、症状性血管痉挛和脑积水患者中 CT 扫描显示弥漫性严重蛛网膜下腔出血的发生率与动脉瘤大小（≥5mm）相关，较大动脉瘤患者的发生率高于较小动脉瘤患者。动脉瘤越大，功能预后越差，6 个月和 2 年生存率越低。
年龄、吸烟史、多发动脉瘤和动脉瘤部位与破裂动脉瘤的大小有关。较大动脉瘤患者临床状况较差，蛛网膜下腔出血更严重，再出血、症状性血管痉挛和脑积水的发生率更高，预后更差。
