超早期神经介入栓塞治疗高龄破裂颅内动脉瘤患者的体会  

Experience in the treatment of ruptured intracranial aneurysms in the elderly by ultra early neuroembolization

作　　者：刘建峰[1] 李辉[1] 井山泉[1] 高金玲[1] 王冀伟 张峰[1] 李鹏[1] 李聪慧 Liu Jianfeng;Li Hui;Jing Shanquan;Gao Jinling;Wang Jiwei;Zhang Feng;Li Peng;Li Conghui(Department of Neurosurgery,the First Hospital of Hebei Medical University,Shijiazhuang 050031,China)

机构地区：[1]河北医科大学第一医院神经外科,石家庄050031

出　　处：《脑与神经疾病杂志》2020年第5期271-275,共5页Journal of Brain and Nervous Diseases

基　　金：河北省卫生与计划生育委员会医学科学研究指导项目(20160688)。

摘　　要：目的探讨超早期神经介入栓塞治疗高龄破裂颅内动脉瘤患者的临床疗效。方法2016年5月至2019年3月21例高龄颅内动脉瘤破裂蛛网膜下腔出血(SAH)的患者接受超早期神经介入栓塞治疗。男性8例,女性13例,年龄70~86岁,平均年龄(75.7±5.6)岁;Hunt-Hess分级:Ⅱ级6例,Ⅲ级7例,Ⅳ级6例,Ⅴ级2例。其中前交通动脉瘤3例,后交通动脉瘤13例,眼动脉瘤1例,大脑中动脉瘤1例,大脑前动脉瘤1例,基底动脉顶端动脉瘤2例。采用改良的Rankin分级量表(mRS)和Glasgow预后分级量表(GOS)评价患者的预后。结果院内死亡2例(9.5%),迟发性血管痉挛3例(14.2%)。19例出院患者中15例(71.4%)恢复良好(mRS 0~2分,GOS4~5),4例(19%)伴有神经功能障碍(mRS 3~5分,GOS2~3),2例(9.5%)出现轻度脑积水。结论超早期神经介入手术综合治疗可以降低高龄颅内动脉瘤破裂患者的死亡率及致残率。Objective To investigate the clinical effect of ultra-early interventional embolization in the treatment of elderly patients with ruptured intracranial aneurysm.Methods 21 elderly patients with ruptured intracranial aneurysms and subarachnoid hemorrhage(SAH)in our hospital from 2016-5 to 2019-3 were treated with ultra-early interventional embolization.There were 8 males and 13 females,70-86 years old,with an average age of(75.7±5.6)years;Hunt Hess grading:6 in grade II,7 in grade III,6 in grade IV and 2 in grade v.Among them,there were 3 cases of anterior communicating aneurysm,13 cases of posterior communicating aneurysm,1 case of ophthalmic aneurysm,1 case of middle cerebral aneurysm,1 case of anterior cerebral aneurysm and 2 cases of top basilar artery aneurysm.The improved Rankin Rating Scale(MRS)and Glasgow prognosis Rating Scale(GOS)were used to evaluate the prognosis of patients.Results 2 cases died in hospital(9.5%),3 cases were delayed vasospasm(14.2%).Among the 19 discharged patients,15(71.4%)recovered well(MRS 0-2,GOS4-5),4(19%)had neurological dysfunction(MRS 3-5,GOS2-3),and 2(9.5%)had mild hydrocephalus.Conclusion the comprehensive treatment of ultra-early neurointerventional surgery can reduce the mortality and disability rate of the elderly patients with ruptured intracranial aneurysm.

关 键 词：神经介入 超早期 高龄 颅内动脉瘤 

分 类 号：R743.32[医药卫生—神经病学与精神病学]