颅内高分级动脉瘤性蛛网膜下腔出血外科干预的随访研究  

Intracranial poor-grade aneurysmal subarachnoid hemorrhage： the follow-up efficacy of surgical intervention

作　　者：李则群[1] 郑匡[1] 赵兵[1] 熊叶[1] 谭显西[1] 钟鸣[1] 史怀璋[2] 梁传声[3] 张鸿祺[4] 赵振伟[5] 王志刚[6] 王汉东[7] 张鑫[7] 杨华[8] 朱刚[9] 

机构地区：[1]温州医科大学附属第一医院神经外科,325000 [2]哈尔滨医科大学附属第一医院神经外科 [3]中国医科大学附属第一医院神经外科 [4]首都医科大学宣武医院神经外科 [5]第四军医大学唐都医院神经外科 [6]山东大学附属第二医院神经外科 [7]南京军区总医院神经外科 [8]贵阳医学院附属医院神经外科 [9]第三军医大学西南医院神经外科

出　　处：《中华神经外科杂志》2016年第2期136-139,共4页Chinese Journal of Neurosurgery

基　　金：卫生部科研基金（WKJ2010-2-016）

摘　　要：目的 观察影响外科干预的颅内高分级动脉瘤性蛛网膜下腔出血（SAH）患者预后的相关因素.方法 2010年10月至2012年3月前瞻性纳入9个中心218例接受开颅手术、血管内治疗或脑室外引流等手术干预的世界神经外科医师联盟分级（WFNS）4/5级患者.登记患者的年龄,入院时的WFNS分级、格拉斯哥昏迷评分（GCS）、Fisher分级、Classeen分级,是否脑疝,呼吸是否平稳,动脉瘤的特点,手术方式,出院时格拉斯哥预后评级（GOS）等,分析影响患者术后1年改良的Rankin量表评分（mRS）的相关因素.结果 出院后1年随访结果显示,74例（33.9％）死亡,27例（12.3％）重残或植物人状态,117例（53.7％）恢复良好.其中WFNS 4级患者恢复良好率为68.9％（91/132）,WFNS 5级为30.2％（26/86）.单因素分析显示,年龄,脑疝,呼吸不稳定,入院时的WFNS分级、GCS评分、Fisher分级、Classeen分级,术前GCS评分,出院时GOS评级等是预后的影响因素;而不同手术方式,手术时机,动脉瘤位置、大小不是影响预后的因素.多因素Logistic回归分析显示,年龄（OR=2.54,95％ CI：1.18 ～ 5.48,P=0.017）、出院时GOS评级（OR=0.028,95％CI：0.004 ～0.208,P＜0.001）是影响1年预后的独立影响因素.结论 针对高分级动脉瘤性SAH,早期积极的外科干预可以取得较好的疗效,患者的年龄、出院时的GOS评级是影响术后1年疗效的主要预测因素.Objective To observe the prognosis-related factors of affecting surgical intervention in patients with poor-grade aneurismal subarachnoid hemorrhage （SAH） Methods From October 2010 to March 2012,218 patients with WFNS grade 4-5 from 9 centers received craniotomy,endovascular treatment or external ventricular drainage,and other surgical interventions were enrolled prospectively.The age of patients,WFNS score on admission,Glasgow coma scale （GCS） score,Fisher grade,Classeen grade,having cerebral hernia or not,having stable breathing or not,characteristics of aneurysm,surgical approach,and Glasgow outcome scale （GOS） grade were registered.The related factors influencing the modified Rankin scale （mRS） scores of the patients at 1 year after procedure were analyzed.Results The followup results at 1 year after discharge showed that 74 patients （33.9%） died,27 （12.3%） had severe disability or in a？ persistent vegetative state,and 117 （53.7%） recovered well.The good recovery rate in patients with WFNS grade 4 was 68.9% （91/132） and that in patients with WFNS grade 5 was 30.2% （26/86）.Univariate analysis showed that that age,herniation,respiratory instability,WFNS grade score on admission,GCS score,Fisher grade,Classeen grade,preoperative GCS score,and GOS score at discharge were the influencing factors of prognosis,while the different surgical modes,timing of surgery,and aneurysm location and size were not the influencing factors of prognosis.Multivariable logistic regression analysis showed that age （OR,2.54,95% CI 1.18-5.48;P=0.017） and GOS score at discharge （OR,0.028,95% CI O.004-0.208;P 〈 0.001） were the independent influencing factors of affecting the 1 year prognosis.Conclusions For poor-grade aneurysmal SAH,early aggressive surgical intervention can achieve better efficacy.The age of patients and GOS grade at discharge are the main predictive factors of affecting the efficacy at 1 year after procedure.

关 键 词：颅内动脉瘤 蛛网膜下腔出血 治疗结果 高分级 外科干预 

分 类 号：R651.12[医药卫生—外科学]