超早期显微手术治疗老年动脉瘤破裂患者临床预后分析

doi:10.3877/cma.j.issn.2095-123X.2017.01.005

目的

分析超早期显微夹闭手术治疗老年动脉瘤破裂患者的临床预后情况。

方法

选取潍坊市脑科医院神经外科2011年9月至2016年9月收治的老年动脉瘤破裂患者130例，按照手术时机分为超早期组64例、早期组42例与中晚期组24例。患者均接受显微夹闭手术治疗，超早期组患者于发病后1 d内手术，早期组患者于发病后1～3 d手术，中晚期组患者则于发病3 d后手术。术后随访3个月，比较3组患者临床预后效果、并发症发生情况。

结果

超早期组患者临床预后效果优于早期组和中晚期组(χ²值分别为4.137、4.043，P<0.05)，早期组患者组与晚期组临床预后效果比较，差异无统计学意义(χ²＝0.031，P>0.05)。超早期组患者术后脑积水发生率明显低于早期组及中晚期组，差异有统计学意义(χ²值分别为4.705、8.282，P<0.05)，早期组患者脑积水发生率与晚期组比较，差异无统计学意义(χ²＝0.530，P>0.05)，3组患者再出血发生率、术后脑梗死发生率比较，差异无统计学意义(P>0.05)。

结论

超早期显微夹闭手术治疗老年动脉瘤患者的临床预后效果良好，并可降低脑积水的发生率。

关键词: 颅内动脉瘤, 预后, 超早期手术

Objective

To analyze the prognostic effect of ultra-early microscopic clip operation in treating the elderly patients with ruptured intracranial aneurysms.

Methods

A total of 130 elderly patients with ruptured intracranial aneurysms were selected in the Department of Neurosurgery, Weifang Brain Hospital from September 2011 to September 2016, and they were divided into ultra-early group (received microscopic clip operation within 1 day after onset, n=64), early group (received microscopic clip operation within 1 day to 3 days after onset, n= 42) and middle-late group groups (received microscopic clip operation after 3 days of onset, n=24) according to operation opportunity. All of the patients were followed up for 3 months, prognostic effect and incidence of complications were compared among the three groups.

Results

The prognostic effect of ultra-early group was statistically significantly better than that of early group (χ²=4.137) and middle-late group (χ²=4.043) , respectively (P<0. 05). There was no significant differences in the prognostic impact between early group (χ²=0.031) and middle-late group(P>0. 05). In the three groups, the rate of hydrocephalus in ultra-early group was significantly lower than that of early group (χ²=4.705) and middle-late group (χ²=8.282), the difference was statistically significant (P<0.05), but there was no significant difference between early group (χ²=0.530) and middle-late group (P>0.05). There were no statistically significant in the three groups in the incidence of rehaemorrhagia and postoperative cerebral infarction (P>0.05).

Conclusion

Ultra-early microscopic clip operation has good prognostic effect and can reduce the incidence of hydrocephalus in treating the elderly patients.

Key words: Intracranial aneurysm, Prognosis, Ultra-early operation

表1 3组患者一般资料比较

组别	例数	年龄(岁，±s)	性别(例，男/女)	Hunt-Hess分级[例(%)]				动脉瘤位置(前循环/后循环)	GCS (分，±s)
组别	例数	年龄(岁，±s)	性别(例，男/女)	Ⅱ	Ⅲ	Ⅳ	Ⅴ	动脉瘤位置(前循环/后循环)	GCS (分，±s)
超早期组	64	70.1±7.9	35/29	32(50%)	17(26.5%)	11(17.2%)	4(6.3%)	55/9	9.3±4.7
早期组	42	68.6±7.7	25/17	20(47.6%)	11(26.2%)	8(19%)	3(7.1%)	36/6	10.2±3.8
中晚期组	24	69.6±6.8	14/10	12(50%)	6(25%)	4(16.7%)	2(8.3%)	21/3	9.6±4.3

表1 3组患者一般资料比较

组别	例数	年龄(岁，±s)	性别(例，男/女)	Hunt-Hess分级[例(%)]				动脉瘤位置(前循环/后循环)	GCS (分，±s)
组别	例数	年龄(岁，±s)	性别(例，男/女)	Ⅱ	Ⅲ	Ⅳ	Ⅴ	动脉瘤位置(前循环/后循环)	GCS (分，±s)
超早期组	64	70.1±7.9	35/29	32(50%)	17(26.5%)	11(17.2%)	4(6.3%)	55/9	9.3±4.7
早期组	42	68.6±7.7	25/17	20(47.6%)	11(26.2%)	8(19%)	3(7.1%)	36/6	10.2±3.8
中晚期组	24	69.6±6.8	14/10	12(50%)	6(25%)	4(16.7%)	2(8.3%)	21/3	9.6±4.3

表2 3组患者GOS得分[例(%)]

组别	例数	1分	2分	3分	4分	5分
超早期组	64	0	1(1.6)	3(4.7)	39(60.1)	21(32.8)
早期组	42	2(4.8)	3(7.1)	3(7.1)	22(52.4)	12(28.6)
晚期组	24	1(4.2)	3(12.5)	1(4.2)	12(50.0)	7(29.2)

表2 3组患者GOS得分[例(%)]

组别	例数	1分	2分	3分	4分	5分
超早期组	64	0	1(1.6)	3(4.7)	39(60.1)	21(32.8)
早期组	42	2(4.8)	3(7.1)	3(7.1)	22(52.4)	12(28.6)
晚期组	24	1(4.2)	3(12.5)	1(4.2)	12(50.0)	7(29.2)

表3 3组患者术后脑积水、脑梗死及再出血发生率[例(%)]

组别	例数	脑积水	脑梗死	再出血
超早期组	64	0	5(7.8)	3(4.4)
早期组	42	3(7.1)	3(7.2)	2(4.8)
中晚期组	24	3(12.5)	2(8.3)	1(4.2)

表3 3组患者术后脑积水、脑梗死及再出血发生率[例(%)]

组别	例数	脑积水	脑梗死	再出血
超早期组	64	0	5(7.8)	3(4.4)
早期组	42	3(7.1)	3(7.2)	2(4.8)
中晚期组	24	3(12.5)	2(8.3)	1(4.2)

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Prognostic effect of ultra-early microscopic clip operation in treating elderly patients with ruptured intracranial aneurysms

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Prognostic effect of ultra-early microscopic clip operation in treating elderly patients with ruptured intracranial aneurysms