超早期血管内栓塞治疗颅内动脉瘤破裂  

Hyper-early embolotherapy in treatment of intracranial ruptured aneurysm

作　　者：李益萍[1] 罗永春[1] 何子骏[1] 沈春森[1] 毛锦龙[1] 孟景山[1] 袁春涛[1] 马尚[1] 张强[1] 梁春阳[1] 徐如祥[1] 

机构地区：[1]北京军区总医院附属八一脑科医院神经外科,100700

出　　处：《中国医师进修杂志》2013年第2期9-11,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨颅内动脉瘤破裂后超早期血管内栓塞治疗的临床效果与安全性。方法回顾性分析33例不同部位颅内动脉瘤破裂患者的临床资料，术前Hunt-Hess分级：Ⅰ-Ⅱ级16例，Ⅲ级5例，Ⅳ级9例，V级3例。在动脉瘤破裂来院6h内气管插管全身麻醉下行电解式可脱性微弹簧圈栓塞治疗。结果术后恢复良好25例（75．8％）；出现偏瘫和单纯运动性失语4例（12．1％），后经综合治疗1个月后逐渐恢复；死亡4例（12．1％），死亡原因：术中动脉瘤破裂出血、术后并发肺部感染、穿刺部位血肿感染、因口服“双抗”并发消化道出血。随访1—6个月，无再出血病例发生。结论超早期血管内栓塞治疗可避免动脉瘤再次破裂出血，减轻脑血管痉挛，未增加术中动脉瘤破裂出血风险性，且超早期血管内栓塞治疗对Hunt．Hess分级Ⅳ-Ⅴ级患者可有效降低病死率。Objective To explore the clinical efficacy and safety of hyper-early embolotherapy in treatment of intracranial ruptured aneurysm. Methods A retrospective analysis was made on 33 patients with intracranial ruptured aneurysm. Preoperative Hunt-Hess grade： grade I - II in 16 patients, grade Ill in 5 patients, grade IV in 9 patients, grade V in 3 patients. All patients were confirmed with subarachnoid hemorrhage （SAH） by angiography and then underwent embolization under general anesthesia by detachable coils within 6 h from onset. Results After operation, 25 patients （75.8%） recovered well, 4 patients （12.1%） were with mild disability with paralysis and aphasia, 4 patients （12.1%） were dead （ 1 patient for intraoperative aneurysm rupture, 1 patient for postoperative pneumonia, 1 patient for infection of hematoma at puncture site and 1 patient for postoperative gastrointestinal bleeding）. Followed up 1-6 months, no rebleeding occurred. Conclusions Hyper-early embolotherapy could avoid rebleeding of the aneurysm, and relieve the vasospasm, without increasing the intra-operative rebleeding rate. Moreover hyper-early embolotherapy could greatly decrease the mortality of poor-grade SAH patients.

关 键 词：颅内动脉瘤 蛛网膜下腔出血 栓塞 治疗性 超早期治疗 

分 类 号：R74[医药卫生—神经病学与精神病学]