高分级动脉瘤性蛛网膜下腔出血的早期手术治疗  

Early surgical treatment for poor-grade aneurysmal subarachnoid hemorrhage

作　　者：王跃飞 孟亮[1] 余小祥[1] 涂勤[1] 樊文 陶亮[1] 李明昌[2] 陈谦学[2] 

机构地区：[1]武汉大学附属同仁医院(武汉市第三医院)神经外科,湖北武汉430000 [2]武汉大学人民医院神经外科,湖北武汉430060

出　　处：《中国现代医学杂志》2017年第21期99-103,共5页China Journal of Modern Medicine

摘　　要：目的探讨高分级动脉瘤性蛛网膜下腔出血的临床特点及早期手术治疗效果。方法回顾性分析36例Hunt-Hess分级Ⅳ、Ⅴ级动脉瘤性蛛网膜下腔出血患者的临床资料。其中,Ⅳ级28例,Ⅴ级8例;显微手术夹闭28例,介入治疗8例。采用出院时格拉斯哥预后评分(GOS)评价患者的预后。结果 2例患者术后出现脑积水并行脑室腹腔分流术,3例出现肺部感染。Hunt-Hess分级Ⅳ级患者预后良好21例,预后不良7例,Ⅴ级患者预后良好3例,预后不良5例,预后良好比分别为75%(21/28)、37.5%(3/8),两组预后比较差异有统计学意义(P<0.05);显微手术夹闭治疗的患者预后良好18例,预后不良10例,死亡3例;介入治疗的患者预后良好6例,预后不良2例,预后良好比分别为64.29%(18/28)、75%(6/8),两者比较预后差异无统计学意义(P>0.05)。结论 Hunt-Hess分级Ⅳ级的患者应根据患者综合情况选择合适的手术方式争取早期手术治疗,Ⅴ级患者早期手术治疗效果尚有待进一步研究。Objective To investigate the clinical efficacy of the early surgical treatment of poor-grade aneurysmal subarachnoid hemorrhage and its clinical features. Methods The clinical data of 36 patients（Hunt-Hess grade Ⅳ or Ⅴ） with aneurysmal subarachnoid hemorrhage were analysed retrospectively. There were 28 patients with Hunt-Hess grade Ⅳ and 8 patients with Hunt-Hess grade Ⅴ. There were 28 patients with microsurgical clipping and 8 patients with interventional embolization. The therapeutic effect was evaluated by Glasgow Outcome Score（GOS）. Results There were 2 patients that underwent V-P shunt because of hydrocephalus and 3 patients with pulmonary infection. Of the patients with Hunt-Hess grade Ⅳ, 21 had good prognosis, 7 had poor prognosis, and of the patients with Hunt-Hess grade Ⅴ, 3 had good prognosis, 5had poor prognosis. The rates of good prognosis were 75%（21/28） and 37.5%（3/8）, respectively. The difference of the prognosis between the two groups was statistically significant（P〈0.05）. Of the patients with microsurgical clipping, 18 had good prognosis, 10 had poor prognosis, 3 were dead. And of the patients with interventional embolization, 6 had good prognosis, 2 had poor prognosis. The rates of good prognosis were64.29%（18/28） and 75%（6/8）, respectively. The difference of the prognosis between the two groups was not statistically significant（P〈0.05）. Conclusions For the patients with Hunt-Hess grade Ⅳ, the early proper surgical treatment should be performed according to the conditions of them. The effectiveness of early surgical treatment remains to be further studied for the patients with Hunt-Hess grade Ⅴ.

关 键 词：蛛网膜下腔出血 颅内动脉瘤 显微手术 介入栓塞 高分级 

分 类 号：R722.151[医药卫生—儿科]