颅内动脉瘤介入栓塞后并发远隔部位血肿的临床分析  

Clinical analysis of remote intracranial hematoma after interventional embolization of intracranial aneurysm

作　　者：程小志 谢韬[2] 何星河 张帅 陈凤 胡均贤[3] 温小燕 牟青春 Cheng Xiaozhi;Xie Tao;He Xinghe;Zhang Shuai;Chen Feng;Hu Junxian;Wen Xiaoyan;Mu Qingchun(Department of Neurosurgery,People's Hospital of Gaozhou,Maoming 525200,China;National Key Clinical Specialty,Engineering Technology Research Center of Ministry of Education,Guangdong Institute of Neurosurgery,Guangdong Key Laboratory of Brain Function Repair and Regeneration,Department of Functional Neurosurgery,Center of Neurosurgery,Southern Medical University,Guangzhou 510282,China;Department of Neurosurgery,Huanggang Central Hospital,Huanggang 438000,China)

机构地区：[1]高州市人民医院神经外科,525200 [2]南方医科大学珠江医院神经外科中心,功能神经外科,国家临床重点专科,脑血管病诊断与治疗教育部工程研究中心,广东省普通高校脑功能修复与再生重点实验室,广东神经外科研究所,广州510282 [3]黄冈市中心医院神经外科,438000

出　　处：《中华神经医学杂志》2021年第11期1149-1153,共5页Chinese Journal of Neuromedicine

基　　金：广东省医学科学技术研究基金(B2021125);茂名市科技计划项目(2021276)。

摘　　要：目的:探讨颅内动脉瘤介入栓塞后并发远隔部位血肿的临床特征及可能机制。方法:回顾性分析黄冈市中心医院神经外科自2016年1月至2018年12月行介入栓塞治疗的58例颅内动脉瘤患者中术后并发远隔部位血肿的6例患者的临床资料,并与同期未并发远隔部位血肿患者进行比较。结果:6例患者中有高血压病史4例、动脉瘤位于颈内动脉5例、术中使用支架且术后常规抗凝治疗5例;所有远隔部位血肿均发生于术后7 d内,且血肿均位于动脉瘤同侧大脑半球。4例患者行颅内血肿穿刺置管引流治疗,1例行保守治疗,1例行开颅治疗;治疗后1例预后良好[改良Rankin量表(mRS)评分1分],1例因预后较差自动出院(mRS评分5分),其余4例遗留一定程度的神经功能障碍(mRS评分3~5分)。与未并发远隔部位血肿的52例患者相比,6例并发远隔部位血肿患者中术中使用支架及术后抗凝治疗者比例更高,出院时预后不良比例更高,差异均有统计学意义(P<0.05)。结论:支架辅助弹簧圈栓塞治疗合并高血压病史的颈内动脉动脉瘤患者时,应高度警惕栓塞后7 d内动脉瘤同侧大脑半球中远隔部位血肿的发生可能。Objective To investigate the clinical characteristics and possible mechanisms of remote intracranial hematoma(RIH)in patients with intracranial aneurysm after interventional embolization.Methods Six patients with RIH from a series of 58 consecutive patients with intracranial aneurysm,admitted to and performed interventional embolization in our hospital from January 2016 and December 2018,were chosen in our study.Their clinical data were analyzed retrospectively and compared with those without RIH at the same period.Results In these 6 patients,4 had history of hypertension,5 had aneurysm located in the internal carotid artery,5 were treated with stents combined with postoperative routine anticoagulation treatment.The remote intracranial hematoma occurred within 7 d of interventional embolization,and the hematoma was located in the cerebral hemisphere on the same side of the aneurysm;4 patients underwent intracranial hematoma puncture catheter drainage;1 patient was treated conservatively,and one was treated by craniotomy.After treatment,1 patient recovered(modified Rankin scale[mRS]score of 1),1 patient had poor prognosis(mRS scores of 5)and discharged automatically,and the rest 4 patients(mRS scores of 3-5)left some degrees of neurological dysfunction.As compared with 52 patients without RIH,6 patients with RIH had significantly higher percentages of patients used stents and postoperatively used anticoagulation,and higher percentages of patients with poor clinical outcomes at discharge(P<0.05).Conclusion Stent-assisted coil embolization in patients with internal carotid artery aneurysm combined with hypertension should be highly vigilant about the possibility of RIH.

关 键 词：远隔部位血肿 颅内动脉瘤 血管内介入 

分 类 号：R651.1[医药卫生—外科学]