Abstract:  Objective　To clarify the spatial distribution of aneurysm rupture location and delayed cerebral ischemia (DCI) induced by aneurysmal subarachnoid hemorrhage (aSAH), and to clarify the predictive value of DCI at different locations for the prognosis of patients after aneurysmal rupture. Methods　A total of 150 patients with aSAH treated at Second Affiliated Hospital of Fujian Medical University from January 2018 to December 2021 were selected, including 90 females and 60 males with an average age of 55. Cranial CT (CCT) scan was performed at least once 24 to 48 h after aneurysm treatment, and again at least 14 days after bleeding event. The distribution characteristics of cerebral lobe DCI corresponding to aneurysms at different locations were analyzed. χ² and t tests were applied. Results　The most common site of ruptured aneurysm was the middle cerebral artery (MCA), accounting for 26.0% (39/150), followed by the anterior cerebral artery (ACA) [22.0%(33/150)]. DCI occurred in 18.0%(27/150) of the patients. DCI was slightly more common in the women than in the men [21.1% (19/90) vs. 13.3% (8/60)]. Aneurysm location had no effect on the incidence of DCI (χ²=2.57, P=0.77). There was no significant difference in the frequency of DCI between anterior and posterior circulation aneurysms [18.7% (25/134) vs. 12.5% (2/16); χ²=0.15, P=0.61]. In the DCI patients, the most frequently involved region was the ipsilateral MCA region [32.0%(8/25)], followed by the ACA region [28.0%(7/25)]. DCI was an important marker of their poor prognosis. Conclusions　In patients with ruptured aneurysm, the occurrence of DCI is related to the distribution of blood supply of parent artery. Therefore, monitoring and warning of specific brain areas in patients with ruptured aneurysms is the premise of drug intervention, which will significantly improve their overall prognosis.

Key words: Ruptured aneurysm, Subarachnoid hemorrhage, Delayed cerebral ischemia, Spatial distribution

摘要： 目的　为了明确动脉瘤蛛网膜下腔出血（aSAH）患者动脉瘤破裂位置与其诱发的迟发性脑缺血（DCI）的空间分布，明确动脉瘤破裂后不同位置DCI对患者预后的预测价值。方法　选取福建医科大学附属第二医院2018年1月至2021年12月aSAH的患者150例，女90例，男60例，平均年龄为55岁。动脉瘤治疗后24～48 h至少进行１次颅脑CT（CCT）扫描，出血事件后至少14 d再次扫描。分析患者不同位置动脉瘤对应的脑叶DCI的分布特点。统计学方法采用χ²检验和t检验。结果　破裂动脉瘤最常见的部位是大脑中动脉（MCA），本组占26.0%（39/150），ACA次之［22.0%（33/150）］；其中18.0%（27/150）的患者发生了DCI。女性罹患DCI的比例略高于男性［21.1%（19/90）比13.3%（8/60）］。动脉瘤位置对迟发性脑梗死发生率无影响（χ²=2.57，P=0.77）。前循环动脉瘤和后循环动脉瘤发生DCI的频率差异无统计学意义［18.7%（25/134）比12.5%（2/16），χ²=0.15，P=0.61］；DCI患者中，最常受影响的区域是同侧MCA区域［32.0%（8/25）］，其次是ACA区域［28.0%（7/25）］。DCI是患者不良预后的重要标志。结论　破裂动脉瘤的患者，DCI的发生与载瘤动脉的血供分布有一定的关系、规律。因此，对于破裂动脉瘤患者特定脑区的监测预警是药物干预的前提，必将明显改善患者整体预后。

关键词: 动脉瘤, 蛛网膜下腔出血, 迟发性脑缺血, 空间分布