双微导管技术治疗老年颅内不规则复杂破裂动脉瘤患者的预后分析  

Prognostic analysis of intracranial irregular and complex aneurysms in elderly patients treated with dual microcatheter technique

作　　者：徐正虎 黄淮 冯佳良 刘欢 高超 王君[3] Xu Zhenghu;Huang Huai;Feng Jialiang;Liu Huan;Gao Chao;Wang Jun(Department of Neurosurgery,Hebei Petro China Central Hospital,Langfang065000,Heibei Province,China)

机构地区：[1]河北中石油中心医院神经外科,廊坊065000 [2]河北中石油中心医院神经内科,廊坊065000 [3]解放军总医院第一医学中心神经内科

出　　处：《中华老年心脑血管病杂志》2023年第4期344-347,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的分析双微导管技术治疗老年颅内不规则复杂破裂动脉瘤患者的预后情况。方法选取2018年4月至2021年5月河北中石油中心医院神经外科收治的老年颅内不规则复杂破裂动脉瘤患者102例,根据不同手术方式分为观察组50例(双微导管技术治疗)和对照组52例(支架辅助栓塞治疗)。随访12个月,比较2组手术指标(手术时间、住院时间、住院费用),术前和出院时采用美国国立卫生研究院卒中量表(NIHSS)评分评估神经功能缺损程度及改良Barthel指数(MBI)评估生活自理能力,观察动脉瘤栓塞程度、预后及并发症发生情况。结果观察组手术时间、住院时间及住院费用明显低于对照组,差异有统计学意义[(2.34±0.61)h vs(3.31±0.45)h,(10.46±2.33)d vs(18.71±3.34)d,(4.58±0.54)万元vs(6.65±0.88)万元,P<0.01]。2组术后NIHSS评分较术前明显降低,MBI评分较术前明显升高,差异有统计学意义(P<0.05)。观察组术后NIHSS评分明显低于对照组,MBI评分明显高于对照组(P<0.05,P<0.01)。观察组致密栓塞及预后良好比例明显高于对照组(78.0%vs 55.8%,P=0.017;82.0%vs 63.5%,P=0.036),并发症发生率明显低于对照组(2.0%vs 15.4%,P=0.031)。结论双微导管技术治疗老年颅内不规则复杂破裂动脉瘤可有效改善患者神经功能、生活自理能力及预后,降低术后并发症,具有良好的推广价值。Objective To analyze the prognosis of intracranial irregular and complex aneurysms in elderly patients after the treatment of double microcatheter technique(DMT).Methods A total of 102elderly patients with irregular and complex intracranial aneurysms treated in Department of Neurosurgery of Hebei Petro China Central Hospital from April 2018to May 2021were enrolled,and then divided into observation group(n=50,treated with DMT)and control group(n=52,stent assisted embolization)according to different surgical methods.All patients were followed up for 12months.The surgical parameters(operative time,hospital stay,hospital cost),severity of neurological deficit(NIHSS score before operation and at discharge)and self-care ability[modified Barthel Index(MBI)]were recorded and compared between the 2groups.The aneurysm clipping,prognosis,and complications were also observed.Results The observation group had significantly shorter operative time and hospital stay and lower hospital costs than the control group[(2.34±0.61)h vs(3.31±0.45)h,(10.46±2.33)d vs(18.71±3.34)d,(4.58±0.54)×10000yuan vs(6.65±0.88)×10000yuan,P<0.01].After treatment,the NIHSS score was decreased and the MBI was increased in both groups(P<0.05),while the observation group obtained obviously lower postoperative NIHSS score and higher postoperative MBI when compared with the control group(P<0.05,P<0.01).The proportion of dense emboli and that with good outcome were higher in the observation group than the control group(78.0%vs 55.8%,P=0.017;82.0%vs 63.5%,P=0.036).The incidence of complications of the observation group was significantly lower than that of the control group(2.0%vs 15.4%,P=0.031).Conclusion DMT is an efficient treatment for intracranial irregular and complex ruptured aneurysms in elderly patients,and can effectively improve neurological function,self-care ability and prognosis,and reduce the occurrence of postoperative complications.It is worthy of clinical promotion and application.

关 键 词：颅内动脉瘤 支架 栓塞 治疗性 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]