早期手术治疗破裂颅内动脉瘤合并急性神经源性肺水肿的临床效果  

Effect of early surgery in the treatment of ruptured intracranial aneurysm complicated with acute neurogenic pulmonary edema

作　　者：王安帮 马晓虎 WANG An-bang;MA Xiao-hu(Neurosurgery Department, the First People's Hospital of Xianyang, Xianyang 712000, China)

机构地区：[1]陕西省咸阳市第一人民医院神经外科,陕西咸阳712000

出　　处：《临床医学研究与实践》2019年第10期72-74,共3页Clinical Research and Practice

摘　　要：目的分析早期手术和保守治疗对破裂颅内动脉瘤合并急性神经源性肺水肿(ANPE)的效果。方法回顾分析我院2013年1月至2018年7月收治的39例破裂颅内动脉瘤合并ANPE的患者的临床资料,将患者按治疗方式的不同将其分为早期组(22例)和保守组(17例)。早期组行早期破裂颅内动脉瘤手术治疗,保守组行单纯侧脑室引流等保守治疗。比较两组术后1个月内生存率、颅内动脉瘤破裂复发率、手术前、手术后24 h的血清脑钠肽(BNP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平、氧合指数、动脉血乳酸水平。结果早期组术后1个月内生存率高于保守组,颅内动脉瘤破裂复发率低于保守组(P<0.05)。手术后24 h,两组的BNP、IL-6和TNF-α水平均降低,且早期组均低于保守组(P<0.05)。手术后24 h,早期组的氧合指数高于术前及保守组,动脉血乳酸水平明显低于术前及保守组(P<0.05)。结论对合并ANPE的破裂颅内动脉瘤患者施行早期手术能有效提高患者生存率,降低颅内动脉瘤破裂复发率,改善患者氧合指数,降低动脉血乳酸、BNP、IL-6、TNF-α等炎症因子水平。Objective To analyze the effect of early surgery and conservative treatment on ruptured intracranial aneurysms complicated with acute neurogenic pulmonary edema (ANPE). Methods The clinical data of 39 patients with ruptured intracranial aneurysms complicated with ANPE admitted in our hospital from January 2013 to July 2018 were retrospectively analyzed. According to the different treatment methods, patients were divided into early group (22 cases) and conservative group (17 cases). The early group underwent early surgical treatment of ruptured intracranial aneurysms, while the conservative group underwent conservative treatment such as simple lateral ventricle drainage. The survival rates, recurrence rates of intracranial aneurysm rupture within 1 month after operation, the levels of serum brain natriuretic peptide (BNP), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α), oxygenation indexes and arterial blood lactic acid before and 24 hours after operation were compared between the two groups. Results The survival rate within 1 month after operation of the early group was higher than that of the conservative group, and the recurrence rate of intracranial aneurysm rupture was lower than that of the conservative group (P<0.05). At 24 hours after operation, the levels of BNP, IL-6 and TNF-α in both groups decreased, and those in the early group were lower than the conservative group (P<0.05). At 24 hours after operation, the oxygenation index of the early group was higher than that before operation and the conservative group, and the level of arterial blood lactic acid was lower than that before operation and the conservative group (P<0.05). Conclusion Early surgery for ruptured intracranial aneurysms complicated with ANPE can effectively improve the survival rate of patients, decrease the recurrence rate of ruptured intracranial aneurysms complicated, improve the oxygenation index, and decrease the levels of arterial blood lactic acid, BNP, IL-6, TNF-α and other inflammatory factors.

关 键 词：破裂颅内动脉瘤 急性神经源性肺水肿 早期手术 

分 类 号：R651.1[医药卫生—外科学]