开颅夹闭治疗动脉瘤性蛛网膜下腔出血的疗效及脑室外引流对患者转归的影响  

Efficacy of early intracranial aneurysm clipping in the treatment of high-grade aneurysmal subarachnoid hemorrhage and effect of external ventricular drainage on the prognosis

作　　者：黄保胜[1,2] 王天路[1] 李帅[2] 李清泉[1] 王森[1] 张雅旋[1] 陈功[2] 李立新[2] 

机构地区：[1]南京医科大学附属逸夫医院神经外科,江苏省210006 [2]南京医科大学第一附属医院神经外科

出　　处：《江苏医药》2016年第23期2543-2546,共4页Jiangsu Medical Journal

基　　金：国家自然科学基金(81501059)

摘　　要：目的分析早期开颅夹闭治疗动脉瘤性蛛网膜下腔出血(aSAH)的疗效及脑室外引流对患者转归的影响。方法高分级aSAH患者62例均分为两组:对照组采用开颅动脉瘤夹闭术;研究组采用开颅夹闭+脑室外引流术。术后1年随访,比较两组转归。结果研究组脑血管痉挛发生率为6.45%,低于对照组的29.03%(P<0.05)。术后1年,研究组转归良好率为41.94%,稍高于对照组的32.26%(P>0.05);两组脑梗死和脑积水等发生率差异无统计学意义(P>0.05)。治疗后两组神经功能和日常生活活动能力评分均较治疗前改善(P<0.05),但两组治疗前和术后1年的评分相仿(P>0.05)。结论采用早期开颅夹闭治疗aSAH可改善患者神经功能及日常生活活动能力,联合实施脑室外引流可明显降低脑血管痉挛发生率。Objective To analyze the efficacy of early intracranial aneurysm clipping in the treatment of high-grade aneurysmal subarachnoid hemorrhage （aSAH ） and the effect of external ventricular drainage on the prognosis .Methods Sixty-two patients with high-grade aSAH were equally divided into two groups of A （treated with intracranial aneurysm clipping and external ventricular drainage） and B （treated with intracranial aneurysm clipping alone ） .The patients were followed up for 1 year and the neurological function（NIHSS） and activity of daily life（BI index） scores were compared .Results The incidence rate of cerebral vasospasm was lower in group A than that in group B（6.45% vs .29.03% ）（P〈0 .05） .The good rate of postoperative recovery was slightly higher in group A than that in group B（41.94% vs .32.26% ）（P〉0 .05） .The incidence rates of cerebral infarction and hydrocephalus in both groups were similar （P〉0 .05） .The scores of NIHSS and BI index in both groups were significantly improved after operation than those before （P〈0 .05） ,which were not significantly different between two groups before and one year after treatment （P〉0 .05） . Conclusion Early intracranial aneurysm clipping in the treatment of high-grade aSAH can improve the neurological function and activity of daily life ,which combined with external ventricular drainage can significantly reduce the incidence of cerebral vasospasm .

关 键 词：动脉瘤性蛛网膜下腔出血 颅内动脉瘤夹闭 脑室外引流 

分 类 号：R743[医药卫生—神经病学与精神病学]