颅内动脉瘤破裂后早期神经介入栓塞的疗效及对神经功能的影响  

Effect of early nerve interventional embolization after intracranial aneurysm rupture and its influence on nerve function

作　　者：孙茂琦[1] 田菲 周民[1] SUN Maoqi;TIAN Fei;ZHOU Min(Department of Neurosurgery,Bengbu First People’s Hospital,Bengbu 233000,China)

机构地区：[1]安徽省蚌埠市第一人民医院神经外科,233000

出　　处：《临床外科杂志》2024年第11期1137-1141,共5页Journal of Clinical Surgery

基　　金：安徽省卫生厅医药科研计划项目(12982KJ2019B26)。

摘　　要：目的探究颅内动脉瘤(IA)破裂后早期神经介入栓塞的疗效及对神经功能的影响。方法2020年1月~2023年1月行神经介入栓塞治疗的IA破裂病人100例,根据手术时机不同分为两组,对照组49例,于IA破裂后24~72小时手术;研究组51例,于IA破裂后24小时内手术。比较两组栓塞成功率、血清炎症-应激因子[白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α、D-二聚体(D-D)、丙二醛(MDA)],脑血管痉挛(CVS)相关因子[缺氧诱导因子(HIF)-1α,可溶性细胞间黏附分子(SICAM)-1,半胱氨酸天冬氨酸蛋白水解酶(Caspase)-3],神经功能(NIHSS评分),日常生活能力(BI评分),并发症(脑血管痉挛)及近期预后。结果研究组栓塞成功率为94.12%,高于对照组的79.59%,两组比较差异有统计学意义(P<0.05);研究组术后第1、3、7天血清IL-6分别为(18.06±5.11)ng/L、(17.15±4.60)ng/L、(16.37±4.35)ng/L,对照组分别为(23.18±5.92)ng/L、(21.23±5.54)ng/L、(20.16±5.29)ng/L,TNF-α分别为(32.01±7.19)ng/ml、(30.67±6.85)ng/ml、(29.45±6.63)ng/ml,对照组分别为(39.01±8.20)ng/ml、(36.22±7.53)ng/ml、(35.01±7.12)ng/ml,D-D分别为(27.19±4.89)μg/ml、(26.20±4.71)μg/ml、(25.81±4.39)μg/ml,对照组分别为(32.06±5.94)μg/ml、(31.18±5.49)μg/ml、(30.26±5.61)μg/ml,MDA分别为(2.81±0.83)μmol/ml、(2.53±0.75)μmol/ml、(2.46±0.71)μmol/ml,对照组分别为(4.02±1.01)μmol/ml、(3.84±0.91)μmol/ml、(3.59±0.86)μmol/ml,两组比较差异有统计学意义(P<0.05);术后第1、3、7天,研究组血清HIF-1α分别为(95.16±8.21)pg/m、(93.25±7.94)pg/m、(92.54±7.80)pg/m,对照组分别为(102.31±8.56)pg/m、(100.27±8.19)pg/m、(99.65±7.92)pg/m,SICAM-1分别为(620.15±78.92)ng/ml、(616.37±75.28)ng/ml、(610.92±73.69)ng/ml,对照组分别为(683.19±80.24)ng/ml、(680.24±78.51)ng/ml、(675.31±75.92)ng/ml,Caspase-3分别为(645.13±88.61)mg/ml、(640.21±85.76)mg/ml、(633.79±82.65)mg/ml,对照组分别为(720.13±90.54)mg/ml、(717.03±88.65)mg/ml、(712.81±85.04)Objective To investigate the effect of early nerve interventional embolization after ruptured intracranial aneurysm(IA)and its effect on nerve function.Methods A total of 100 patients with ruptured IA who underwent neurointerventional embolization in our hospital from January 2020 to January 2023 were selected and divided into two groups according to the timing of surgery.The control group(n=49)underwent surgery 24-72 hours after rupture of IA,while the study group(n=51)underwent surgery within 24 hours after rupture of IA.The success rate of embolization,serum inflammatory stress factor[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),D-dimer(D-D),malondialdehyde(MDA)],cerebrovascular spasticity(CVS)related factors[hypoxia-inducing factor 1α(HIF-1α)],soluble intercellular adhesion molecule-1(SICAM-1),cysteine aspartate proteolytic enzyme 3(Caspase-3),neurological function(NIHSS score),capacity of daily living(BI score),complications(cerebral vasospasm)and short-term prognosis were compared between the two groups.Results The success rate of embolization in the study group was 94.12%,which was higher than that in the control group(79.59%)(P<0.05).The serum IL-6 levels in the study group on day 1,3,and 7 after surgery were(18.06±5.11)ng/L,(17.15±4.60)ng/L,and(16.37±4.35)ng/L,respectively,while those in the control group were(23.18±5.92)ng/L,(21.23±5.54)ng/L,and(20.16±5.29)ng/L,respectively,the TNF-αlevels were(32.01±7.19)ng/ml,(30.67±6.85)ng/ml,and(29.45±6.63)ng/ml,respectively,while those in the control group were(39.01±8.20)ng/ml,(36.22±7.53)ng/ml,and(35.01±7.12)ng/ml,respectively,the D-D levels were(27.19±4.89)μg/ml,(26.20±4.71)μg/ml,and(25.81±4.39)μg/ml,respectively,while those in the control group were(32.06±5.94)μg/ml,(31.18±5.49)μg/ml,and(30.26±5.61)μg/ml,respectively,the MDA levels were(2.81±0.83)μmol/ml,(2.53±0.75)μmol/ml,and(2.46±0.71)μmol/ml,respectively,while those in the control group were(4.02±1.01)μmol/ml,(3.84±0.91)μmol/ml,and(3.59±0.86)μmol/ml,respectively

关 键 词：颅内动脉瘤 破裂 神经介入栓塞 疗效 神经功能 

分 类 号：R743[医药卫生—神经病学与精神病学]