不同治疗方式对高分级动脉瘤性蛛网膜下腔出血患者预后的影响  

Different treatments on the prognosis of poor-grade aneurysmal subarachnoid hemorrhage patients

作　　者：丁璇[1] 王志刚[1] 王成伟[1] 王益华[1] 

机构地区：[1]山东大学第二医院神经外科,济南250033

出　　处：《中华医学杂志》2012年第43期3054-3057,共4页National Medical Journal of China

基　　金：山东省科技计划项目（2008GG10002060）

摘　　要：目的观察对比手术夹闭、介入治疗和保守治疗对高分级动脉瘤患者的治疗效果。方法回顾性分析2004年6月至2011年12月山东大学第二医院神经外科收治的世界神经外科医师联盟（WFNS）分级Ⅳ、V级患者119例。其中WFNSIV级73例，V级46例。男51例，女68例，年龄32—77岁，平均55．2岁。手术夹闭57例，介入栓塞40例，保守治疗22例。术后3个月行格拉斯哥预后评分（cos）。结果手术夹闭组预后好（5—4分）22例（38．6％）；预后差（3—2分）30例（52．6％）；死亡（1分）5例（8．8％）。介入栓塞组预后好26例（65．0％）；预后差1例（2．5％）；死亡13例（32．5％）。保守治疗组预后好0例；预后差3例（13，6％）；死亡19例（86．4％）。介入栓塞预后好的结果高于手术夹闭和保守治疗（P〈0．05），病死率高于手术夹闭（P〈0．05），保守组的病死率明显高于前两组（P〈0．05）。结论对于WFNS1V级患者，手术夹闭和介入栓塞均可选择；在WFNSV级患者中，介入栓塞可作为首选；当WFNSIV级和V级患者合并脑内较大血肿（血肿量〉30ml）时，应首选手术夹闭。Objective To compare the outcomes of surgical clipping, interventional treatment and conservative treatment of poor-grade aneurysm patients. Methods A total of 119 patients of WFNS （ World Federation of Neurosurgieal Societies ） grades 1V （ n = 73 ） and V （ n = 46 ） from June 2004 from to December 2011 were analyzed. There were 51 males and 68 female with a mean age of 55.2 years （range： 32 -77）. The approaches included surgical clipping （ n = 57 ）, intervenfional embolization （ n = 40 ） and conservative treatment （ n = 22 ）. Their outcome were assessed with a 3-month follow-up according to the Glasgow outcome score （GOS）. Results In surgical clipping group, the prognoses were excellent （5 -4 points, n = 22）, poor prognosis （ 3 - 2 points, n = 30 ） mad death （ 1 point, n = 5 ） ; excellent （ n = 26 ）, poor （ n = 1 ） and death （ n = 13 ） in interventional embolization group ; excellent （ n = 0 ）, poor （ n = 3 ） and death （ n = 19） in conservative treatment. The excellent outcome of interventional embolism was better than those of surgical clipping and conservative treatment （ P 〈 0. 05 ） , but it had higher mortality than surgical clipping （P 〈 0. 05）. In conservative treatment group, mortality was significantly higher than the first two groups （ P 〈 0.05 ）. Conclusion For patients of grade IV, surgical clipping and interventional embolization may be selected; for those of grade V, interventional embolization can be used as a first choice ; for those of grade IV/V with large intracerebral hematoma （hematoma volume 〉 30 ml ）, surgical clipping is preferred.

关 键 词：高分级动脉瘤 手术夹闭 介入栓塞 保守治疗 

分 类 号：R743.35[医药卫生—神经病学与精神病学]