治疗时机对动脉瘤性蛛网膜下腔出血患者预后的影响  

Effect of treatment timing on the prognosis of patients with aneurysmal subarachnoid hemorrhage

作　　者：唐必英 李钢[2] Biying Tang;Gang Li(The First Clinical College of Hainan Medical University,Haikou 570000,China;Department of Neurosurgery,Sanya Central Hospital(the Third People's Hospital of Hainan Province),Sanya 572000,China)

机构地区：[1]海南医科大学第一临床学院,海口570000 [2]三亚中心医院(海南省第三人民医院)神经外科,三亚572000

出　　处：《中华神经创伤外科电子杂志》2024年第4期213-219,共7页Chinese Journal Of Neurotraumatic Surgery:Electronic Edition

基　　金：海南省自然科学基金高层次人才项目(822RC874)

摘　　要：目的探讨不同治疗时机对不同Hunt-Hess分级的动脉瘤性蛛网膜下腔出血(aSAH)患者预后的疗效。方法回顾性分析三亚中心医院神经外科自2017年1月到2022年12月收治的331例aSAH患者的临床资料,根据术前Hunt-Hess分级将患者分为低分级组(Hunt-HessⅠ~Ⅲ级,265例)和高分级组(Hunt-HessⅣ~Ⅴ级,66例);根据手术方式的不同分为低分级开颅治疗、低分级介入治疗、高分级开颅治疗及高分级介入治疗。依据治疗时机不同,将低分级组分为超早期治疗(<24 h)、早期治疗(24~72 h)与延迟治疗(>72 h);高分级组分为超早期治疗(<24 h)与非超早期治疗(≥24 h)。比较不同治疗时机低分级、高分级aSAH患者的术后并发症和预后情况,分析预后与治疗时机的相关性。结果开颅或介入治疗的不同分级的患者在各治疗时机的术后并发症发生情况比较,差异均无统计学意义(P>0.05);开颅或介入治疗的低分级aSAH患者在超早期治疗、早期治疗、延迟治疗的术后改良Rankin量表(mRS)评分比较,差异无统计学意义(P>0.05);开颅或介入治疗的高分级aSAH患者在超早期治疗、非超早期治疗的术后mRS评分比较,差异有统计学意义(P<0.05)。相关性分析显示,高分级aSAH患者开颅、介入治疗的预后与治疗时机具有相关性(r=0.352、0.481,P<0.05)。结论低分级aSAH患者行开颅或介入手术治疗整体预后较好,不同治疗时机对预后无影响;高分级aSAH患者行超早期开颅或介入手术治疗的整体预后较非超早期治疗有改善,有助于提高患者的生存质量。Objective To explore the effect of different treatment timing on prognosis of aneurysmal subarachnoid hemorrhage(aSAH)patients with different Hunt-Hess grades.Methods Clinical data of 331 patients with aSAH admitted to Neurosurgery Department of Sanya Central Hospital from January 2017 to December 2022 were retrospectively analyzed,and were divided into low-grade group(Hunt-Hess gradesⅠ-Ⅲ,265 cases)and high-grade group(Hunt-Hess gradesⅣ-Ⅴ,66 cases)according to preoperative Hunt-Hess grading.According to different surgical methods,it can be divided into low-grade craniotomy treatment,low-grade interventional treatment,high-grade craniotomy treatment,and high-grade interventional treatment.According to the timing of treatment,low-grade patients are classified into ultra-early treatment(<24 h),early treatment(24-72 h),and delayed treatment(>72 h);High grading is divided into ultra-early treatment(<24 h)and non-ultra-early treatment(≥24 h).The postoperative complications and prognosis of patients with low-grade and high-grade aSAH at different treatment timings were compared,and the correlation between prognosis and treatment timing was analyzed.Results There was no statistically significant difference in postoperative complications among patients of different grades undergoing craniotomy or interventional therapy at different treatment opportunities(P>0.05);There was no statistically significant difference in the postoperative modified Rankin scale(mRS)scores of low-grade aSAH patients undergoing craniotomy or interventional treatment between ultra-early treatment,early treatment,and delayed treatment(P>0.05);There was a statistically significant difference in postoperative mRS scores of high-grade aSAH patients undergoing craniotomy or interventional treatment between ultra-early treatment and non-ultra-early treatment(P<0.05).Correlation analysis showed that the prognosis of advanced aSAH patients undergoing surgery and interventional treatment is correlated with the timing of treatment(r=0.352,0.481,P<0

关 键 词：动脉瘤性蛛网膜下腔出血 治疗时机 开颅治疗 介入治疗 预后 

分 类 号：R743.35[医药卫生—神经病学与精神病学]