高级别颅内动脉瘤保守治疗后行血管内栓塞治疗的预后观察

doi:10.3877/cma.j.issn.2095-123X.2018.01.008

目的

探讨颅内囊状动脉瘤Hunt-Hess Ⅳ~Ⅴ分级患者给予保守治疗后行血管内栓塞治疗的预后效果。

方法

回顾性分析大连大学附属中山医院神经外一科自2012年1月至2017年12月收治的64例颅内囊状动脉瘤Hunt-Hess Ⅳ~Ⅴ分级（Ⅳ级48例，Ⅴ级16例）患者的临床资料，其中32例患者入院后采取保守治疗，待意识状态较前有所改善或者散大瞳孔的直径较前有所减小，行血管内栓塞联合持续腰大池引流治疗，为暂缓手术组；另外32例急诊行血管内栓塞联合持续腰大池引流治疗，为即刻手术组。对2组患者治疗后第1、3、6月的预后进行评价。

结果

暂缓手术组与即刻手术组比较，治疗后1个月GCS评分差异均无统计学意义（P>0.05）；治疗后3个月Rankin量表评分差异无统计学意义（P>0.05），治疗后6个月差异有统计学意义（P<0.05）。

结论

高级别颅内动脉瘤患者保守治疗后行血管内栓塞术术后6个月的预后优于入院即刻行颅内动脉瘤栓塞术的患者。

关键词: 高级别蛛网膜下腔出血, 颅内动脉瘤, 血管内栓塞治疗

Objective

To observe the prognosis of patients with Hunt-hess lV-V grade of intracranial saccular aneurysms who were treated with conservative therapy.

Methods

The clinical date of 64 patients with Hunt-Hess grade Ⅳ-Ⅴ intracranial saccular aneurysm (grade Ⅳ, n=48 and grade Ⅴ, n=16) admitted to Fist Department of Neurosurgery of Affiliated Zhongshan Hospital of Dalian University from January 2012 to December 2017 were analyzed retrospectively. Thirty two cases of them were treated with conservative therapy in which the state of consciousness was better than before or the pupil was smaller than before,and then they were treated with embolization and continuous lumbar drainage(postpone surgery group) and 32 underwent emergency embolization and continuous lumbar drainage(immediate surgery group). The neurological prognosis of the patients was evaluated at 1, 3 and 6 months.

Results

There was no significant difference in Glasgow outcome scores between the postpone surgery group and immediata surgery group at one month after treatment (P>0.05); there was no significant difference in Rankin prognostic scores at three months after treatment (P>0.05); But there was significant difference in Rankin prognostic scores at six months after treatment between the two groups (P<0.05).

Conclusion

Patients with high grade cystic aneurysmal subarachnoid hemorrhage can be treated with conservation treatment. When patients were treated with conservative therapy in which the state of consciousness was better than before or the pupil was smaller than before,endovascular embolization and continuous lumbar drainagemay be performed. The prognosis at six months is better than emergency embolization and continuous lumbar drainage.

Key words: High grade subarachnoid hemorrhage, Intracranial aneurysms, Endovascular embolization

表1 2组高级别颅内动脉瘤患者一般资料比较（Mean±SD）

级别	例数	年龄（岁）	病程（h）	瘤颈（mm）	Hunt?Hess（例）
级别	例数	年龄（岁）	病程（h）	瘤颈（mm）	Ⅳ级	Ⅴ级
暂缓射手组	32	51±12	12.4±1.3	11.7±0.3	24	8
即刻手术组	32	52±11	13.2±2.1	9.5±0.6	24	8
t/χ²值	?	0.348	1.702	1.864	1.000	1.000
P值	?	0.623	0.086	0.064	0.342	0.342

表1 2组高级别颅内动脉瘤患者一般资料比较（Mean±SD）

级别	例数	年龄（岁）	病程（h）	瘤颈（mm）	Hunt?Hess（例）
级别	例数	年龄（岁）	病程（h）	瘤颈（mm）	Ⅳ级	Ⅴ级
暂缓射手组	32	51±12	12.4±1.3	11.7±0.3	24	8
即刻手术组	32	52±11	13.2±2.1	9.5±0.6	24	8
t/χ²值	?	0.348	1.702	1.864	1.000	1.000
P值	?	0.623	0.086	0.064	0.342	0.342

表2 高级别颅内动脉瘤位置分布（例）

组别	例数	前循环			后循环			合计
组别	例数	前交通动脉	后交通动脉	颈动脉分叉	椎动脉	小脑下前动脉	小脑后下动脉	合计
暂缓手术组	32	?	?	?	?	?	?	?
Ⅳ级	?	8	2	2	4	6	2	24
Ⅴ级	?	2	0	0	2	2	2	8
即刻手术组	32	?	?	?	?	?	?	?
Ⅳ级	?	8	2	2	4	6	2	24
Ⅴ级	?	2	0	0	2	2	2	8

表2 高级别颅内动脉瘤位置分布（例）

组别	例数	前循环			后循环			合计
组别	例数	前交通动脉	后交通动脉	颈动脉分叉	椎动脉	小脑下前动脉	小脑后下动脉	合计
暂缓手术组	32	?	?	?	?	?	?	?
Ⅳ级	?	8	2	2	4	6	2	24
Ⅴ级	?	2	0	0	2	2	2	8
即刻手术组	32	?	?	?	?	?	?	?
Ⅳ级	?	8	2	2	4	6	2	24
Ⅴ级	?	2	0	0	2	2	2	8

表3 2组颅内动脉瘤Hunt-Hess Ⅳ~Ⅴ级患者术前、术后1、3、6个月评分比较（Mean±SD，分）

组别	例数	GCS评分		Rankin量表
组别	例数	术前	术后1个月	术后3个月	术后6个月
暂缓手术组	32	3.8±1.3	3.7±1.4	3.7±1.7	3.0±1.5
即刻手术组	32	3.7±1.3	3.8±1.3	3.6±1.5	4.2±1.8
t值	?	0.307	0.297	0.250	2.899
P值	?	0.542	0.591	0.634	0.008

表3 2组颅内动脉瘤Hunt-Hess Ⅳ~Ⅴ级患者术前、术后1、3、6个月评分比较（Mean±SD，分）

组别	例数	GCS评分		Rankin量表
组别	例数	术前	术后1个月	术后3个月	术后6个月
暂缓手术组	32	3.8±1.3	3.7±1.4	3.7±1.7	3.0±1.5
即刻手术组	32	3.7±1.3	3.8±1.3	3.6±1.5	4.2±1.8
t值	?	0.307	0.297	0.250	2.899
P值	?	0.542	0.591	0.634	0.008

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Prognostic observation of endovascular embolization for high grade intracranial aneurysms after conservation treatment

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Prognostic observation of endovascular embolization for high grade intracranial aneurysms after conservation treatment