超早期栓塞治疗颅内动脉瘤破裂致蛛网膜下腔出血临床观察  

Clinical observation of ultra-early embolization for subarachnoid hemorrhage caused by ruptured intracranial aneurysms

作　　者：朱顺利 张玉龙 刘振法 王晖 石明亮 李江琳[2] ZHU Shunli;ZHANG Yulong;LIU Zhenfa;WANG Hui;SHI Mingliang;LI Jianglin(Kaifeng Hospital of Traditional Chinese Medicine,Kaifeng 475001,China;The First Affiliated Hospital of Henan University,Kaifeng 475001,China)

机构地区：[1]开封市中医院,河南开封475002 [2]河南大学第一附属医院,河南开封475001

出　　处：《中国实用神经疾病杂志》2020年第5期449-453,共5页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然科学基金项目(编号:81601368);河南省科技攻关计划项目(编号:172102310284);开封市科技发展计划项目(编号:1603085);河南省高等学校重点科研项目计划(编号:16B320005);河南大学本科教学改革研究与实践项目(编号:HDXJJG2018-131);河南大学临床医学院教研项目(编号:LCYX1902)。

摘　　要：目的总结超早期血管内栓塞治疗颅内动脉瘤致蛛网膜下腔出血的并发症及预后。方法回顾性分析2015-07—2018-06开封市中医院和河南大学第一附属医院的62例超早期(<12 h)颅内动脉瘤栓塞手术患者和同期65例常规(>24 h)颅内动脉瘤栓塞手术患者的资料。结果术后超早期组发生并发症20例(32.3%),常规组38例(53.8%),差异有统计学意义(P<0.05)。出院GOS分级超早期组与常规组差异有统计学意义(P<0.05)。术后随访1 a,GOS分级超早期组与常规组差异有统计学意义(P<0.05)。超早期组死亡4例,常规组7例,差异有统计学意义(P<0.05);各有1例在1 a内发生动脉瘤再破裂出血,差异无统计学意义(P>0.05)。WFNS分级Ⅳ级患者预后随访超早期组24例,良好17例(65.4%),较差6例(31.5%),死亡1例(4.2%);常规组26例,良好11例(44.4%),较差12例(46.8%),死亡3例(11.5%);超早期组预后良好率高于常规组(Z=3.002,P=0.015)。WFNS分级V级患者预后随访超早期组6例,良好1例(16.7%),较差2例(33.3%),死亡3例(50.0%);常规组7例,良好1例(14.3%),较差2例(28.6%),死亡4例(57.1%),预后比较差异无统计学意义(Z=1.033。P=0.181)。结论发病12 h内的超早期血管内栓塞治疗可减少颅内动脉瘤致蛛网膜下腔出血并发症发生率,改善非重症患者预后。Objective To summarize the experience of ultra-early endovascular embolization in the treatment of complications and prognosis of subarachnoid hemorrhage caused by intracranial aneurysm.Methods From July 2015 to June 2018,62 cases of ultra-early(<12 h)intracranial aneurysm embolization surgery in Kaifeng Hospital of Traditional Chinese Medicine and the First Affiliated Hospital of Henan University and 65 cases of routine(>24 h)intracranial surgery during the same period undergoing aneurysm embolization surgery were retrospectively analyzed.Results There were 20(32.3%)cases of complications in the ultra-early group and 38(53.8%)cases of complications in the routine group(P<0.05).There was a significant difference of GOS between the two groups when patients leave hospital(P<0.05).After 1 year follow-up,the difference of GOS between the two groups was statistically significant(P<0.05).There were 4 cases of death in the ultra-early group and 7 cases of death in the routine group(P<0.05).There was 1 case of recurrence of ruptured aneurysm in the ultra-early group and same in the routine group(P>0.05).In the follow-up of patients with WFNS gradeⅣ,there were 24 cases in the ultra-early group,17 cases were good(65.4%),6 cases were poor(31.5%),and 1 patient died(4.2%);in the routine group,there were 26 cases,11 cases were good(44.4%),12 cases were poor(46.8%),and 3 patients died(11.5%).In the super early group,the good prognosis rate was higher than that in the routine group(Z=3.002,P=0.015).In the follow-up of patients with WFNS gradeⅣ,there were 6 cases in the ultra-early group,good in 1 case(16.7%),poor in 2 cases(33.3%),and 3 patients died(50%);in the routine group,there were 7 cases,good in 1 case(14.3%),poor in 2 cases(28.6%),and 4 patients died(57.1%).There was no significant difference in the prognosis between the two groups(Z=1.033,P=0.181).Conclusion Ultra-early endovascular embolization(<12 hours)can reduce the complications of subarachnoid hemorrhage caused by intracranial aneurysm and improve the prognosi

关 键 词：颅内动脉瘤 蛛网膜下腔出血 栓塞 手术时机 手术后并发症 

分 类 号：R743.35[医药卫生—神经病学与精神病学]