颅内动脉瘤破裂急性期与非急性期手术184例分析  

Early and non-early surgery for ruptured intracranial aneurysms： analysis of 184 cases

作　　者：吴群[1] 吴盛[1] 凌晨晗[1] 张建民[1] 陈高[1] 祝向东[1] 傅伟明[1] 胡华[1] 张宏[1] 沈宏[1] 赵学群[1] 

机构地区：[1]浙江大学医学院附属第二医院神经外科,杭州310009

出　　处：《中华急诊医学杂志》2010年第8期858-861,共4页Chinese Journal of Emergency Medicine

基　　金：浙江省科技厅重大科技专项（2009C13G2010083）;杭州市科技局推进社会发展专项重点项目（20061123804）

摘　　要：目的 比较颅内动脉瘤破裂急性期和非急性期手术治疗的优缺点.方法 对2008年12月至2009年9月浙江大学医学院附属第二医院184例颅内动脉瘤破裂的数据进行回顾性分析.将动脉瘤破裂后3 d内行手术治疗的患者归入急性期手术组（102例）,将破裂后大于3 d再行手术治疗的患者归入非急性期手术组（82例）.组间比较采用成组设计的t检验;率比较采用x2检验.研究两者之间在术前再出血率,术中完全夹闭率,术后脑梗死、脑积水发生率等方面的差异.在6～12个月的随访中,通过格拉斯哥预后评分（glasgow outcome scale,GOS）计分,分析两组患者手术预后的差异.结果 急性期组术前再出血2例,非急性期组再出血7例;术前再出血率差异具有统计学意义（P＜0.05）.急性期组完全夹闭率91.2%（93/102）,非急性期组完全夹闭率80.5%（66/82）,差异具有统计学意义（P＜0.05）.急性期手术组患者术后脑梗死发生率10.8%（11/102）,术后脑积水发生率6.86%（7/102）.非急性期组术后脑梗死发生率4.88%（4/82）,术后脑积水发生率3.66%（3/82）.两组之间差异无统计学意义.术后随访中,将患者根据GOS评分分为死亡（1分）,致残（2～3分）,良好（4～5分）.非急性期组7例死亡,11例致残,55例恢复良好;急性期组8例死亡,16例致残,73例恢复良好,急性期组良好率较高,但两组间差异无统计学意义.结论 ①急性期手术可以明显减少术前再次出血,从而减低因术前出血引起的死亡致残风险.②急性期手术术中可以通过腰大池置管引流等方法降低颅内压,明显提高完全夹闭率,促进患者的康复.Objective To compare the therapeutic efficacy between emergency and non-emergency operation for ruptured intracranial anemysms. Method A retrospective analysis of 184 patients with ruptured intracranial aneurysms the Second Affiliated Hospital Zhejiang University College of Medicine, admitted from Dec 2008 to Sep 2009, was carried out to evaluate the efficacy of operation to be done earlier. The patients were divided into 2 groups according to the time of surgery. In the early operation group （ n = 102）, the patients were operated on within 3 days of rupture of aneurysms, and in the delayed operation group （ n = 82）, the patients were operated on after 3 days. The comparison in the rate of rebleeding before surgery, rate of complete occlusion of the ruptured aneurysm and rate of major complications such as cerebral infarction and hydrocephalus between two groups was made. The Glasgow outcome scale （GOS） scores of these patients were also evaluated by 6- 12 months follow-up after operation. Results Preoperative re-bleeding happened in 2 patients of the early operation group and in 7 patients of the delayed operation group. The rates were significantly different （ P 〈 0.05）. The complete occlusion rate in the early operation group was 91.2% （93/102）, while was 80.5% （66/82） in the delayed operation group （P 〈 0.05）. There were no statistically significant differences in post-operative cerebral infarction rate, post-operative hydrocephalus rate or GOS scores on follow-up between two groups. Conclusions Early operation can significantly reduce the re-bleeding before surgery, reducing the risk of death and disability. In early operation, the continuous lumbar drainage by cannulation and other methods can be used to reduce intracranial pressure, signifi- cantly increasing the rate of complete occlusion, and promoting rehabilitation.

关 键 词：颅内动脉瘤 动脉瘤破裂 蛛网膜下腔出血 急性期手术 非急性期手术 再出血 脑梗塞 脑积水 预后 

分 类 号：R651.12[医药卫生—外科学]