目的：探讨动脉瘤性蛛网膜下腔出血（ aneurysmal subarachnoid hemorrhage， aSAH）后分流依赖性脑积水（ shunt-dependent hydrocephalus， SDHC）的危险因素，比较Fisher分级系统中开颅动脉瘤夹闭或血管内栓塞对aSAH后SDHC的影响。方法回顾性分析我院2011年7月至2014年6月收治的768例经开颅夹闭或血管内栓塞治疗的aSAH患者的临床资料，分为分流组（151例）与非分流组（617例）探讨SDHC的危险因素，并根据Fisher分级系统，分析不同治疗方式对SDHC的影响。结果 SDHC发生的危险因素包括：年龄大于等于40岁，Hunt-Hess（ H-H）分级Ⅲ、Ⅳ、Ⅴ级，Fisher分级Ⅲ、Ⅳ级，急性脑积水，脑室内出血（ intraventricular hemorrhage， IVH）。 Fisher分级Ⅱ级的患者，栓塞治疗有较低的SDHC发生率；Fisher分级Ⅳ级的患者，开颅夹闭治疗有较低的SDHC发生率。结论SDHC的高发生率与患者的高龄、较差的起始神经系统状态、急性脑积水、脑室内出血有关。 Fisher分级Ⅱ级的患者选取栓塞治疗，Ⅳ级的患者选取夹闭治疗，可明显降低SDHC发生，改善患者预后；Fisher分级Ⅰ、Ⅲ级的患者，两种治疗方式对SDHC的发生无影响。%Objective The risk factors for shunt-dependent hydrocephalus ( SDHC ) in aneurysmal subarachnoid hemorrhage (aSAH) patients are discussed and the influence of microsurgical clipping or endovascular coil embolization treatment for SDHC in aSAH patients are compared according to Fisher grading system.Methods A retrospective review was conducted in 768 patients with aSAH who underwent microsurgical clipping or endovascular coiling in our hospital from July 2011 to June 2014.The patients were divided into two groups ( shunt group, 151 patients;non-shunt group, 617 patients ) and risk factors for SDHC were analyzed.The effects of two different treatments for aSAH patients with SDHC according to Fisher grading system were analyzed.Results Independent risk factors for SDHC after aSAH were as follows:≥40 years;Hunt-Hess gradeⅢ, IV or V;Fisher grade III or IV;acute hydrocephalus and intraventricular hemorrhage (IVH).In Fisher gradeⅡpatients, the coiling group showed lower incidence of SDHC, while in Fisher grade IV patients, the clipping group showed lower incidence of SDHC. Conclusion A significant higher rate of SDHC is observed for senior patients with poor initial neurological status, acute hydrocephalus and intraventricular hemorrhage.Fisher gradeⅡpatient prefers endovascular treatment and Fisher grade IV patient prefer microsurgical treatment, which reduce the incidence of SDHC and improve the prognosis of patients.For patients with Fisher gradeⅠandⅢ, there is no significant difference between two different treatments for SDHC.
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