颅内破裂动脉瘤早期显微手术疗效及预后相关因素分析  

Factors and outcomes associated with early surgery for ruptured intracranial aneurysms:A single centre retrospective analysis

作　　者：余建军[1] 李江[1] 顾昌伟[2] 

机构地区：[1]宁波大学医学院附属医院神经外科,浙江宁波315000 [2]东南大学医学院附属江阴医院神经外科,江苏江阴214400

出　　处：《中国现代医生》2016年第18期4-8,共5页China Modern Doctor

基　　金：浙江省宁波市自然科学基金(2013A610251)

摘　　要：目的评价早期显微手术治疗颅内破裂动脉瘤的临床疗效及探讨其预后影响因素。方法回顾性分析2008年1月～2015年1月我科收治的147例颅内破裂动脉瘤患者的临床资料，分为低分级动脉瘤（Hunt—HessⅠ -Ⅲ）组104例，高分级动脉瘤（Hunt—Hess Ⅳ-Ⅴ）组43例，115例行超早期手术（发病后24h之内），32例行早期手术（发病后72h之内）。采用格拉斯哥评分（GOS）评价患者的预后。结果低分级动脉瘤组预后优良率（GOS4～5）89．4％。明显高于高分级动脉瘤组的预后优良率（44．2％），差异有统计学意义（P〈0．05）；术前未出血组急诊手术干预有效率显著高于术前再出血组，差异有统计学意义（P〈0．05）；术后合并局灶性或多灶性脑梗死组预后有效率与非梗死组对比差异无统计学意义（P〈0．05），而合并大面积脑梗死组预后有效率与非梗死组对比差异有统计学意义（P〈0．05）。结论早期或超早期手术可降低颅内破裂动脉瘤再出血风险，尽早缓解颅内高压，效果良好。术前再出血、术后合并大面积脑梗死患者预后往往不佳。Objective To assess the efficacy of early microsurgery for ruptured intracranial aneurysms and to investigate the factors affecting prognosis. Methods Clinical data of 147 patients of ruptured intracranial aneurysm from Jan 2008 to Jan 2015 were respectively analyzed. All cases were divided into low-grade aneurysms （Hunt-Hess Ⅰ -Ⅲ, 104 pa- tients） and high-grade（Hunt-Hess Ⅳ-Ⅴ, 43 patients）. 115 patients received ultra-early operation（within first 24 hours after onset）, 32 patients received early operation （within first 72 hours after onset）.Outcome was assessed by Glasgow Outcome Scale（GOS）. Results The favorable outcome rate（GOS 4-5） in low-grade aneurysm group was 89.4%, sig- nificantly higher than the rate in the high-grade aneurysm group（44.2%）, and the difference was statistically significant （P〈0.05）. Emergency surgical intervention effective rate in the preoperative non-bleeding group was significantly higher than the rate in the preoperative bleeding group, and the difference was statistically significant（P〈0.05）. Compared with the favorable outcome rate in the postoperative non-infarction group, there was no statistically significant difference in the group merging focal cerebral infarction or the group merging multifocal cerebral infarction（P＇〉0.05）. But there was statistically significant difference in the favorable outcome rate between the group merging large area cerebral infarction and postoperative non-infarction group（P〈O.05）. Conclusion The early or ultra-early microsurgery can avoid the risk of aneurysmal re-rupture and decrease intracranial hypertension as soon as possible.The results are satisfactory. The prognosis of re-bleeding patients before operation or patients with large area cerebral infarction after operation is sig- nificantly poor.

关 键 词：蛛网膜下腔出血 颅内动脉瘤 再出血 显微外科手术 手术时机 

分 类 号：R651.1[医药卫生—外科学]