重症颅内动脉瘤性蛛网膜下腔出血的超早期手术夹闭治疗  

Ultra-early surgery for severe intracranial aneurismal hemorrhage

作　　者：潘剑威[1] 童鹰[1] 詹仁雅[1] 周永庆[1] 郑杰胜[1] 沈剑峰[1] 万曙[1] 严敏[1] 范卫健[1] 

机构地区：[1]浙江大学医学院附属第一医院神经外科,杭州310003

出　　处：《中华神经外科杂志》2009年第4期343-345,共3页Chinese Journal of Neurosurgery

摘　　要：目的探讨颅内动脉瘤破裂超早期手术治疗的可行性和治疗效果。方法13例不同部位颅内动脉瘤患者，经三维CT造影（3D-CTA）检查证实后即在24h内全麻下行开颅动脉瘤夹闭术，其中6h内手术5例、6-24h手术8例。术前Hunt-Hess分级：Ⅳ级10例，V级3例。术后根据出院时GOS结果评价治疗效果。结果术中发生动脉瘤破裂并临时阻断4例，分离困难6例；术后出现脑积水并行脑室腹腔分流术3例，肺部感染3例，下丘脑反应伴上消化道出血2例，额叶梗死1例；出院时效果良好6例；预后差5例；死亡2例。结论对Hunt-Hess分级Ⅳ-V级的患者实施超早期手术治疗可避免动脉瘤早期再次破裂出血；3D-CTA的应用使超早期手术成为可能，改善治疗效果。Objective To discuss the possibility and therapeutic effect of ultra-early surgery for grade IV - V intracranial aneurysms scored by Hunt-Hess grading system. Methods Thirteen cases suffered from intracranial aneurysms determined by 3D - CTA were treated by ultra-early surgery under general anesthesia within 24 hours （5 cases were treated within 6 hours and 8 cases in 6 -24 hours）. Preoperative Hunt-Hess grade：10 cases were grade IV and 3 cases were grade V. The therapeutic effects were evaluated by Glasgow Outcome Score （GOS）. Results In operation, difficult dissection occurred in 6 cases, rupture of aneurysm occurred and temporary obstructions were performed in 4 cases. After the clipping of aneurysms, there were 3 cases underwent V-P shunt because of hydrocephalus, 3 cases of pulmonary infection, 2 cases of hypothalamus reaction accompanied with hemorrhage in upper digestive tract and 1 case of frontal infarction. The therapeutic effects were good in 6 cases, worse in 5 cases, dead in 2 cases. Conclusions IThe ultra-early surgery could avoid early re-bleeding of intracranial aneurysm and is suitable for intracranial aneurysms of Hunt-Hess grade IV - V. The application of 3D-CTA could make it possible for using ultra-early surgery, and improve the therapeutic effect.

关 键 词：颅内动脉瘤 超早期 手术 

分 类 号：R686[医药卫生—骨科学]