Hunt—HessⅢ～Ⅳ级动脉瘤性蛛网膜下腔出血患者血管介入栓塞与开颅夹闭手术后并发脑积水差异的比较及预后分析  

Comparison of extent of postoperative hydrocephalus in patients between intervertional therapy with embolism and craniotomy occlusion in Hunt-Hess Ⅲ-Ⅳ level aneurysm induced subarachnoid hemorrhage and their prognosis

作　　者：刘洋[1] 孙圣凯[2] 陈旭义[1] 程世翔[1] 秦至臻[3] 刘秀[1] 陈孝储[2] 宁莉莉[2] 王志宏[2] 

机构地区：[1]辽宁医学院武警后勤学院附属医院培养基地,武警后勤学院附属医院脑科医院,天津市神经创伤修复重点实验室,天津300162 [2]武警后勤学院附属医院医教部,天津300162 [3]武警总医院神经肿瘤外科,北京100000

出　　处：《中华危重病急救医学》2015年第2期133-137,共5页Chinese Critical Care Medicine

基　　金：基金项目：国家自然科学基金青年科学基金项目（11102235）;天津市自然科学基金重点项目（12JCZDJC24100）;天津市科技支撑计划重点项目（14ZCZDGX00005）

摘　　要：目的 分析比较Hunt—HessⅢ～Ⅳ级动脉瘤性蛛网膜下腔出血（aSAH）患者血管介入栓塞与开颅夹闭手术后并发急性脑积水的差异及预后。方法 回顾性分析武警后勤学院附属医院和武警总医院2011年1月至2014年7月接受血管介入栓塞（介入栓塞组，403例）或开颅夹闭手术（开颅夹闭组，364例）的Hunt—HessⅢ～Ⅳ级aSAH患者的临床资料，筛选出术后出现急性脑积水的病例，运用统计学方法对可能造成两组术后脑积水形成差异的因素进行量化与赋值，通过出院时格拉斯哥预后评分（GOS）判断脑积水患者短期预后情况，比较两种手术的优缺点。结果 介入栓塞组403例患者中术后出现脑积水56例（13．90％），开颅夹闭组364例患者中术后出现脑积水33例（9．07％），两组脑积水发生率差异有统计学意义（X^2=4．350，P=0．037）。767例aSAH患者中，行血肿清除者脑积水发生率显著低于未行血肿清除者[3．07％（11／358）比19．07％（78／409），X^2=47．635，P=0．0003；行脑室引流者脑积水发生率显著低于未行脑室引流者[2．77％（19／685）比85．37％（70／82），X^2=487．032，P=0．000]。在介入栓塞组403例患者中，行血肿清除者脑积水发生率略低于未行血肿清除者[8．06％（5／62）比14．96％（51／341），X^2=2．082，P=0．168]；行脑室引流者脑积水发生率显著低于未行脑室引流者[2．59％（9／347）比83．93％（47／56），X^2=266．599，P=0．000]。在开颅夹闭组364例患者中，行血肿清除者脑积水发生率显著低于未行血肿清除者[2．03％（6／296）比39．71％（27／68），）X^2=95．226，P=0．000]；行脑室引流者脑积水发生率显著低于未行脑室引流者[2．96％（10／338）比88．46％（23／26），X^2=203．852，P=0．000]。介入栓塞组与开颅夹闭组之间行血肿清除者脑积水发生率差异有统计学意义[8．06％（5／Objective To analyze and compare the difference and prognosis between vascular embolization and craniotomy occlusion in patients suffering from aneurysmal subarachnoid hemorrhage （aSAH） with Hunt-Hess level Ⅲ-Ⅳ , and acute postoperative hydrocephalus. Methods A retrospective study was conducted on 767 patients who had undergone vascular embolization （vascular embolization group, n = 403 ） or craniotomy occlusion operation （craniotomy occlusion operation group, n = 364 ）, and the patients with postoperative acute hydrocephalus were screened. The clinical data of patients of both groups was analyzed. By judging short-term prognosis in patients with hydrocephalus with Glasgow outcome scale （GOS） score estimated at discharge, the advantages and disadvantages of two surgical procedures were compared. Results The number of cases with postoperative hydrocephalus in vascular embolization group was 56 （13.90%）, while that in craniotomy occlusion group was 33 （9.07%）. The difference between the two groups of incidence of hydrocephalus was statistically significant （ X^2 = 4.350, P = 0.037 ）. In 767 patients with aSAH, the incidence of hydrocephalus among the patients after the hematoma removal operation was significantly lower than that of patients without hematoma removal [ 3.07% （ 11/358 ） vs. 19.07% （78/409）, X^2 = 47.635, P = 0.000]. The incidence of hydrocephalus among the patients after ventricular drainage was significantly lower than that of patients without the drainage [2.77% （19/685） vs. 85.37% （70/82）, X^2 = 487.032, P = 0.000]. In 403 cases of vascular embolization group, the incidence of hydrocephalus in the patients after the hematoma removal operation was lower than that of patients without it [ 8.06% （5/62） vs. 14.96% （51/341 ）, X^2 = 2.082, P = 0.168 ]. The incidence of hydrocephalus in the patients after the ventricular drainage was lower than that of patients without drainage [ 2.59% （9/347） vs. 83.93% （47/56）, X^2 = 266.599, P = 0.000 ]. I

关 键 词：蛛网膜下腔出血 动脉瘤 脑积水 Hunt—Hess分级 

分 类 号：R651.1[医药卫生—外科学]