血管介入栓塞术与显微瘤颈夹闭术治疗动脉瘤性蛛网膜下腔出血的临床效果比较  

Comparison of the clinical effects of vascular interventional embolization and microsurgical neck clipping in the treatment of aneurysmal subarachnoid hemorrhage

作　　者：刘辉 耿海威 刘懿 刘美香 LIU Hui;GENG Hai-wei;LIU Yi;LIU Mei-xiang(WardⅢof Neurology Department,Kaifeng Central Hospital,Kaifeng 475000,Henan,CHINA)

机构地区：[1]开封市中心医院神经内科三病区,河南开封475000

出　　处：《海南医学》2025年第7期949-953,共5页Hainan Medical Journal

基　　金：河南省科技计划项目(编号:202102310348)。

摘　　要：目的比较血管介入栓塞术与显微瘤颈夹闭术治疗动脉瘤性蛛网膜下腔出血(aSAH)的临床效果。方法回顾性分析2020年1月至2024年5月开封市中心医院接收的280例aSAH患者的临床资料,按照不同治疗方式分组,其中90例采用显微瘤颈夹闭术治疗者纳入对照组,190例采用血管介入栓塞术治疗者纳入研究组。术前及术后3 d,比较两组患者的红细胞沉降率、白细胞计数水平、C反应蛋白;术前及术后3个月,比较两组患者的美国国立卫生研究所卒中量表(NIHSS)评分;术后3个月,比较两组患者的短期预后和并发症发生情况;出院前,比较两组患者的住院时间。结果术前,两组患者的红细胞沉降率、白细胞计数、C反应蛋白水平比较差异均无统计学意义(P>0.05);术后3 d,两组患者的红细胞沉降率、白细胞计数、C反应蛋白水平均上升,且研究组患者的红细胞沉降率、白细胞计数、C反应蛋白水平分别为(21.20±2.68)mm/h、(11.96±2.17)×10^(9)/L、(12.70±2.55)mg/L,明显低于对照组的(23.85±2.49)mm/h、(14.75±2.42)×10^(9)/L、(16.38±2.64)mg/L,差异均有统计学意义(P<0.05)。术前,两组患者的NIHSS评分比较差异无统计学意义(P>0.05);术后3个月,两组患者的NIHSS评分均较术前降低,且研究组患者的NIHSS评分为(10.79±1.48)分,明显低于对照组的(14.62±1.57)分,差异均有统计学意义(P<0.05)。术后3个月,研究组患者的预后良好率为81.05%,明显高于对照组的70.00%,并发症总发生率为3.16%,明显低于对照组的10.00%,差异均有统计学意义(P<0.05);研究组患者的住院时间为(16.71±2.50)d,明显短于对照组的(22.65±3.11)d,差异有统计学意义(P<0.05)。结论血管介入栓塞术较显微瘤颈夹闭术治疗aSAH更有优势,对炎症反应的影响更小,更能改善患者NIHSS评分及短期预后,术后并发症发生率更低。Objective To compare the clinical effects of vascular interventional embolization and microsurgical neck clipping in the treatment of aneurysmal subarachnoid hemorrhage(aSAH).Methods A retrospective analysis was conducted on the clinical data of 280 patients with aSAH admitted to Kaifeng Central Hospital from January 2020 to May 2024.The patients were divided into different treatment groups based on the treatment modality.Among them,90 patients who underwent microsurgical neck clipping were included in the control group,while 190 patients treated with vascular interventional embolization were included in the study group.Before surgery and 3 days after surgery,the erythrocyte sedimentation rate,white blood cell count,and C-reactive protein levels were compared between the two groups of patients.Before surgery and 3 months after surgery,the National Institutes of Health Stroke Scale(NIHSS)scores were compared between the two groups.Three months after surgery,the short-term prognosis and incidence of complications between the two groups were compared.Before discharge,the hospitalization time was compared between the two groups of patients.Results Before surgery,the differences in erythrocyte sedimentation rate,white blood cell count,and C-reactive protein levels between the two groups of patients were not statistically significant(P>0.05).Three days after surgery,the erythrocyte sedimentation rate,white blood cell count,and C-reactive protein levels increased in both groups.However,the erythrocyte sedimentation rate,white blood cell count,and C-reactive protein levels of the study group were(21.20±2.68)mm/h,(11.96±2.17)×10^(9)/L,and(12.70±2.55)mg/L,respectively,which were lower than(23.85±2.49)mm/h,(14.75±2.42)×10^(9)/L,and(16.38±2.64)mg/L of the control group(P<0.05).Before surgery,the difference in NIHSS scores between the two groups of patients was not statistically significant(P>0.05).Three months after surgery,the NIHSS scores of both groups of patients decreased compared to preoperative levels;the NIHS

关 键 词：动脉瘤性蛛网膜下腔出血 栓塞术 颈夹闭术 预后 

分 类 号：R654[医药卫生—外科学]