血管内栓塞术与显微开颅夹闭术对颅内前循环动脉瘤患者血流动力学及生活质量的影响比较  

Comparison of the effects of endovascular embolization and microsurgical craniotomy on hemodynamics and quality of life in patients with anterior circulation intracranial aneurysm

作　　者：程宇宏 李志良 白福平 Cheng Yuhong;Li Zhiliang;Bai Fuping(Department of Neurosurgery,Linfen Central Hospital,Linfen,Shanxi 041000,China)

机构地区：[1]临汾市中心医院神经外科,山西省041000

出　　处：《中国基层医药》2020年第23期2890-2894,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的:比较血管内栓塞术与显微开颅夹闭术对颅内前循环动脉瘤患者血流动力学及生活质量的影响。方法:以2014年1月至2018年12月临汾市中心医院收治的颅内前循环动脉瘤患者63例为研究对象,根据患者手术不同,分为A组(显微开颅夹闭术)30例和B组(血管内栓塞术)33例。比较两组患者术前(T0)、术中(T1)、术毕(T2)及术后24 h(T3)心率、收缩压、舒张压、心输出量、每搏心输出量和心脏排血指数的变化情况,出院时采用MOS健康状况调查问卷(SF-36)评价患者生活质量,通过格拉斯哥预后评分(GOS)量表评估两组患者术后3个月预后状况,分别采用日常生活活动能力和改良Barthel指数量表评估患者术后2年生活质量和并发症的发生情况。结果:相比A组,B组T1时心脏排血指数[(2.86±0.63)L·min-1·(m 2)-1比(3.39±0.83)L·min-1·(m 2)-1]明显升高,心率[(90±15)次/min比(79±9)次/min]、收缩压[(132±18)mmHg比(123±9)mmHg]、舒张压[(96±13)mmHg比(89±12)mmHg]和每博心输出量[(88.64±18.53)mL比(78.54±13.35)mL]均明显下降(t=2.50、3.61、2.89、2.63、3.02,均P<0.05);相比A组,B组T2时心率[(86±12)次/min比(75±11)次/min]、收缩压[(134±20)mmHg比(122±11)mmHg]和舒张压[(93±11)mmHg比(77±14)mmHg]均明显下降,T3时收缩压[(128±13)mmHg比(113±14)mmHg]和舒张压[(85±9)mmHg比(78±13)mmHg]均明显下降(t=2.68、3.14、3.95、4.15、3.05,均P<0.05)。B组出院时SF-36量表中的精力[(55.07±8.76)分]、生理职能[(53.65±8.62)分]、生理功能[(62.25±9.53)分]、精神健康[(72.26±13.95)分]、情感职能[(61.89±12.25)分]和总体健康[(47.63±8.61)分]评分均明显高于A组[(45.86±7.62)分、(49.21±9.76)分、(43.58±8.75)分、(50.14±10.33)分、(44.76±9.42)分、(35.86±7.60)分](t=4.43、2.35、8.07、7.09、6.18、5.73,均P<0.05)。两组患者术后3个月GOS评分的比较,差异无统计学意义(P>0.05)。随访2年,B组日常生活活动能力[(86.89±4.54)分]和改良BarthelObjective To compare the effects of two different surgical methods(endovascular embolization and microsurgical craniotomy)on hemodynamics and quality of life in patients with anterior circulation aneurysms.Methods From January 2014 to December 2018,63 patients with anterior circulation aneurysms in Linfen Central Hospital were divided into group A(micro craniotomy)30 cases and group B(intravascular embolization)33 cases according to the different operation method.The changes of heart rate,systolic blood pressure,diastolic blood pressure,cardiac output,cardiac output per stroke and cardiac output index were compared between the two groups before operation(T0),during operation(T1),after operation(T2)and 24 hours after operation(T3).The quality of life of the patients was evaluated by the MOS 36-item short-form health status survey(SF-36)at the time of discharge from hospital,and the prognosis of the patients at three months after operation was evaluated by Glasgow outcome score(GOS).The quality of life and complications were evaluated by the ability of daily living and the modified Barthel index.Results Compared with group A,group B showed a significant increase in cardiac output index[(2.86±0.63)L·min-1·(m2)-1 vs.(3.39±0.83)L·min-1·(m2)-1],a significant decrease in heart rate[(90±15)times/min vs.(79±9)times/min],systolic blood pressure[(132±18)mmHg vs.(123±9)mmHg],diastolic blood pressure[(96±13)mmHg vs.(89±12)mmHg]and cardiac output per stroke[(88.64±18.53)mL vs.(78.54±13.35)mL]at T1(t=2.50,3.61,2.89,2.63,3.02,all P<0.05).Compared with group A,group B showed a significant decrease in heart rate[(86±12)times/min vs.(75±11)times/min],systolic blood pressure[(134±20)mmHg vs.(122±11)mmHg]and diastolic blood pressure[(93±11)mmHg vs.(77±14)mmHg]at T2,and a significant decrease in systolic blood pressure[(128±13)mmHg vs.(113±14)mmHg]and diastolic blood pressure[(85±9)mmHg vs.(78±13)mmHg]at T3(t=2.68,3.14,3.95,4.15,3.05,all P<0.05).The scores of energy[(55.07±8.76)points],physiological function[(

关 键 词：颅内动脉瘤 颅内前循环 血管内栓塞术 显微开颅夹闭术 血流动力学 格拉斯哥预后评分 改良BARTHEL指数 生活质量 

分 类 号：R651.12[医药卫生—外科学]