不同时机血管内介入栓塞术治疗Ⅰ~Ⅲ级颅内动脉瘤破裂的临床疗效  

Clinical efficacy of intravascular embolization at different times in the treatment of ruptured grade Ⅰ-Ⅲ intracranial aneurysms

作　　者：沈寻 贾建文[2] 王文蕾 秦怀海 Shen Xun;Jia Jianwen;Wang Wenlei;Qin Huaihai(Department of Neurosurgery,Emergency General Hospital,Beijing 100028,China;Department of Neurosurgery,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]应急总医院神经外科,北京100028 [2]首都医科大学附属北京朝阳医院神经外科,北京100020

出　　处：《血管与腔内血管外科杂志》2021年第11期1358-1362,共5页Journal of Vascular and Endovascular Surgery

摘　　要：目的 探讨发病后72 h以内行血管内介入栓塞术治疗Ⅰ~Ⅲ级颅内动脉瘤破裂的临床疗效.方法 收集2018年1月至2021年1月于应急总医院接受血管内介入栓塞术治疗的79例Ⅰ~Ⅲ级颅内动脉瘤破裂患者的临床资料,将在发病后72 h以内(含72 h)接受治疗的47例患者作为观察组,将在发病72 h后接受治疗的32例患者作为延迟组.比较两组患者的栓塞效果,手术前后的血清神经与血管相关标志物[半胱氨酸蛋白酶抑制剂C(Cys-C)、神经元特异性烯醇化酶(NSE)、中枢神经特异性蛋白100-β亚型(S100-β)、基质金属蛋白酶9(MMP9)、内皮素-1(ET-1)]水平、血清炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)]水平,以及术中出血、术后并发症的发生率.比较两组患者的临床疗效.结果 观察组患者的栓塞成功率为95.74%(45/47),高于延迟组患者的78.13%(25/32),差异有统计学意义(P=0.039).术后,观察组患者的Cys-C、NSE、S100-β、MMP9、ET-1 TNF-α、IL-6、CRP水平均低于延迟组患者,差异均有统计学意义(P<0.05).观察组患者术后再出血的发生率低于延迟组患者,差异有统计学意义(P<0.05).观察组患者的临床疗效优于延迟组患者,差异有统计学意义(P=0.047).结论 发病后72 h以内采用血管介入栓塞术治疗Ⅰ~Ⅲ级颅内动脉瘤破裂可获得更加良好的栓塞效果和临床疗效,能够减轻患者的炎性反应,改善神经与血管相关标志物水平,降低术后并发症的发生率.Objective To investigate the clinical efficacy of intravascular interventional embolization in the treatment of grade Ⅰ-Ⅲ ruptured intracranial aneurysms 72 hours after onset. Method The clinical data of 79 patients with grade Ⅰ-Ⅲ ruptured intracranial aneurysms treated by intravascular interventional embolization in the Emergency General Hospital from January 2018 to January 2021 were collected. A total of 47 patients treated within 72 hours(including 72 hours) after the onset of the disease were used as the observation group, and 32 patients treated 72 hours after the onset of the disease were used as the delay group. The embolization effects of the two groups were compared, and the serum nerve and vascular related markers [cystatin C(Cys-C), neuron specific enolase(NSE), beta subunit of specific protein S100 protein(S100-β), matrix metalloproteinase 9(MMP9), endothelin-1(ET-1)] levels, serum inflammatory factors [tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), C-reactive protein(CRP)] and the incidence of intraoperative bleeding and postoperative complications. The clinical effects of the two groups were compared. Result The success rate of embolization in the observation group was 95.74%(45/47), which was higher than 78.13%(25/32) in the delayed group(P=0.039). After operation, the levels of Cys-C, NSE, S100-β, MMP9, ET-1, TNF-α, IL-6 and CRP in the delayed group were lower than those in the delayed group(P<0.05). The incidence of postoperative rebleeding in the observation group was lower than that in the delayed group(P<0.05). The clinical efficacy of the observation group was better than that of the delay group, and the difference was statistically significant(P=0.047). Conclusion Intravascular embolization in the treatment of grade Ⅰ-Ⅲ intracranial aneurysm rupture within 72 hours after onset can obtain better embolization effect and clinical curative effect, reduce the inflammatory reaction of patients, improve the level of nerve and vascular related markers, and reduce the incidenc

关 键 词：低级别 颅内动脉瘤 破裂 出血 血管内介入栓塞术 手术时间 

分 类 号：R543[医药卫生—心血管疾病]