不同治疗时期对高分级动脉瘤性蛛网膜下腔出血患者预后的影响  

Timing of treatment 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45期3211-3214,共4页National Medical Journal of China

基　　金：山东省科技计划项目（2008GG10002060）

摘　　要：目的研究对比超早期、早期、中期及晚期治疗对高分级动脉瘤患者预后的影响。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（WVrqS）分级Ⅳ、V级动脉瘤患者，共119例。其中Ⅳ级73例，V级46例。男51例，女68例，年龄平均55．2岁。手术夹闭57例，其中超早期2例，早期14例，中期28例，晚期13例；介入栓塞40例，超早期14例，早期16例，中期8例，晚期2例；保守治疗22例。术后3个月行格拉斯哥预后评分。结果超早期治疗中，手术夹闭预后好0例，介入栓塞预后好13例；两者预后差分别为2例，0例；死亡分别为0例，1例。早期治疗两者分别为：预后好5例，13例；预后差9例，0例；死亡0例，3例；中期：预后好17例，0例；预后差10例，0例；死亡1例，8例；晚期：预后好0例，0例；预后差9例，1例；死亡4例，1例。结论Ⅳ级患者治疗时期越早效果越好；V级患者超早期和早期治疗结果好于中晚期；中期治疗死亡率最高，晚期治疗总体预后最差；保守治疗治疗各时期预后均差。Objective To explore the prognostic effects of ultra-early, early, medium-term and late treatments of poor-grade aneurysm patients. Methods A total of 119 patients of WFNS IV and V, including WFNS IV grade （n =73） and Vgrade （n =46）, were analyzed. There were 51 males and 68 female with a mean age of 55.2 years. Among them, 57 cases underwent surgical clipping, including ultra- early treatment （ n = 2）, early treatment （ n = 14）, medium-term treatment （ n = 28 ） and late treatment （n = 13） ; 40 cases underwent intervenfional embolizatian, including ultra-early treatment （n = 14）, early treatment （n = 16 ）, medium-term treatment （ n = 8 ）, late treatment （ n = 2） and conservative treatment （ n = 22）. The outcomes were assessed according to the Glasgow outcome score during a 3-month follow-up. Results There was 0 case of a good prognosis in surgical clipping group with ultra-early treatment versus 13 of good prognosis in interventional embolization group; poor prognosis 2 vs 0 and death 0 vs 1 in two groups respeetively. Early treatment： good prognosis 5 vs 13; poor prognosis 9 vs 0; death 0 vs 3; Medium-term treatment ： good prognosis 17 vs 0 ; poor prognosis 10 vs 0 ; death 1 vs 8 ; Late treatment： good prognosis 0 vs 0 ; poor prognosis 9 vs 1 ; death 4 vs 1. Conclusion For patients of WFNS IV grade, the treatment should be performed as soon as possible. For patients in WFNS V grade, ultra-early and early treatments fare better than medium-term and late treatments. The mortality of medium-term treatment is the highest. Overall prognosis of late treatment has the worst outcome. Regardless of treatment period, eonservative treatment shows the worst prognosis and the highest mortality.

关 键 词：动脉瘤 预后 评估 

分 类 号：R651.1[医药卫生—外科学]