【作者】 贺涛； 武丽娜； 陈彬； 邢怡桥；

【Author】 He Tao,WU li-na,Chen bin,Xing Yi-qiao, Department of Ophthalmology,Renmin Hospital of Wuhan University,Wuhan 430060,China

【机构】 武汉大学人民医院眼科；

【摘要】 目的探讨因动脉瘤破裂致蛛网膜下腔出血(subarachnoid hemorrhage,SAH)而引起Terson综合征的发生率及其相关因素的分析。方法本研究为前瞻性研究,对2009年11月至2010年5月期间在我院神经外科确诊为动脉瘤性蛛网膜下腔出血的连续病例101例(202眼)进行观察。所有患者均行直接眼底镜检查,统计分析Terson综合征的发生率,分析性别、年龄、神经外科专科情况如意识状态、格拉斯哥昏迷评分(Glasgow Coma Scale score,GCS)及Hunt-Hess分级、动脉瘤位置及死亡率等相关因素与Terson综合征的关系。结果在101例动脉瘤性蛛网膜下腔出血患者中有15例(24眼)发生Terson综合征,发生率为14.85%。统计分析结果显示不同性别间Terson综合征发生率的差异不具有统计学意义(χ~2=0.615,P=0.433);Terson综合征的发生与患者意识状态、GCS评分、Hunt-Hess分级存在显著关系(P<0.05),意识障碍、GCS评分较低及Hunt-Hess分级较高的患者Terson综合征发生率较高;但与动脉瘤的位置(P=1.000)和患者的死亡率(P=0.158)无相关性。随访期间发现有1例需行手术治疗。结论动脉瘤性蛛网膜下腔出血患者Terson综合征的发生率较高(14.85%),其发生与患者的全身情况存在明显相关性,因此对意识障碍、GCS评分较低和Hunt-Hess分级较高的患者应重视眼科情况,常规行眼底检查。Terson综合征是否能够用来判断SAH患者的预后可能还需进一步探讨。Terson综合征患者绝大多数眼内出血可自行吸收,仅少数病例需行手术治疗。更多还原

【Abstract】 Objective To investigate the incidence and relative factors of Terson’s syndrome in patients with aneurysmal subarachnoid hemorrhage(SAH).Methods A prospective case series study was conducted in 202 eyes of 101 patients with aneurysmal subarachnoid hemorrhage from November 2009 to May 2010.A careful direct funduscopic examination was performed in all participants.The incidence of Terson’s syndrome was analyzed and correlated with gender,consciousness state,Glasgow Coma Scale score(GCS) and Hunt-Hess grade, anatomical locations of the ruptured aneurysms, mortality rate.Results Terson’s syndrome was diagnosed in a total of 24 eyes of 15(14.85%) of 101 aneurysmal subarachnoid hemorrhage patients. Analysis of our data revealed no statistically significant difference between men and women in regard to the incidence of Terson’s syndrome(χ~2= 0.615,P=0.433).A significant relationship was observed between consciousness state,GCS score, Hunt-Hess grade and the incidence of Terson’s syndrome(P<0.05).A higher frequency of Terson’s syndrome was demonstrated in patients with consciousness disturbance,lower GCS score and higher Hunt-Hess grade.However,no correlation was found between localization of the ruptured aneurysm(P= 1.000),mortality rate (P=0.158) and the occurrence of Terson’s syndrome.One case required surgical treatment during follow-up.Conclusions A higher frequency(14.85%) of Terson’s syndrome was observed in patients with aneurysmal subarachnoid hemorrhage,which had association with clinical conditions significantly.Therefore,the SAH patients with consciousness disturbance,lower GCS score and higher Hunt-Hess grade should be paid attention to ophthalmic conditions and performed fundus examination.The occurrence of Terson’s syndrome needs to be further explored whether to determine the prognosis in SAH patients.Terson’s hemorrhage absorbed spontaneously in most patients and required surgical intervention in very few patients.更多还原