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为探讨蛛网膜下腔出血(SAH)合并硬膜下血肿(SDH)的临床特点和机制,对根据 CT、脑血管造影、手术和尸解证实的颅内动脉瘤破裂致 SAH 合并 SDH 的16例进行临床特点分析,并对其中11例作病理检查,探索其发生机制。此组病例临床表现严重,68.8%病例有意识障碍,43.8%见有玻璃体下出血,81.3%病例死亡。导致 SAH 合并 SDH 的原因可能为:动脉瘤破裂,大量血液破入蛛网膜下腔,撕破蛛网膜;伴随的脑内血肿破入蛛网膜下腔并撕破蛛网膜;发病时突发意识丧失、摔倒致头部外伤。结论:颅内动脉瘤可致 SAH 合并 SDH,其生命预后不佳,病死率高,CT 阴性者不能完全排除合并 SDH 的可能。
To investigate the clinical features and mechanisms of subarachnoid hemorrhage (SAH) combined with subdural hematoma (SDH), 16 patients with SAH complicated with SDH according to CT, cerebral angiography, surgical and autopsy confirmed intracranial aneurysm rupture Clinical features were analyzed and 11 of them were pathologically examined to explore their mechanism. This group of patients with severe clinical manifestations, 68.8% of patients with disturbance of consciousness, 43.8% see vitreous hemorrhage, 81.3% of the cases died. Causes of SAH combined with SDH may be due to aneurysm rupture, a large number of blood into the subarachnoid space, tear the arachnoid; accompanying intracerebral hematoma broken into the subarachnoid space and tear arachnoid; sudden loss of consciousness onset , Fell to the head caused by trauma. Conclusion: Intracranial aneurysms can cause SAH combined with SDH, its poor prognosis, high mortality, CT negative can not completely rule out the possibility of SDH.