摘要
目的探讨不同手术时机对高分级颅内动脉瘤患者的影响。方法回顾性分析86例Hunt-Hess分级Ⅳ~Ⅴ级动脉瘤性蛛网膜下腔出血患者的临床资料,并根据手术时机不同将其分为超早期组（手术时间于发病后24 h内）40例,早期组（发病24~72 h）27例,中晚期组（发病〉72 h）19例;术后6个月采用改良Rankin量表（mRS）评分评价预后,比较3组患者在预后良好率（mRS为0~2分）、病死率等方面的差异。结果 （1）超早期、早期及中晚期预后良好比率分别为55.0%（22例）、33.3%（9例）、21.1%（4例）,差异有统计学意义（P〈0.05）;病死率超早期（7.5%,3例）低于早期（25.9%,7例）及中晚期（42.1%,8例）,差异有统计学意义（P〈0.05）。（2）Ⅳ级患者不同手术时机的预后良好率差异有统计学意义（P〈0.05）;Ⅴ级患者不同手术时机的预后良好率差异无统计学意义（P〉0.05）,3组患者病死比例分别为2/18、4/11和6/11,差异有统计学意义（P〈0.05）。结论超早期手术可能会使部分高分级颅内动脉瘤患者受益,特别是Ⅳ级患者。对于Ⅴ级动脉瘤患者,超早期手术有助于降低短期病死率,但植物状态生存率高。
Objective To investigate the influence of different timing of surgery on patients with poor-grade intracranial aneurysm. Methods The clinical data of 86 patients with aneurysmal subarachnoid hemorrhage（ Hunt-Hess grade Ⅳ to Ⅴ） were analyzed retrospectively. The patients were divided into an ultra-early treatment group（ the operative time within 24 h after onset; n = 40）,an early treatment group,（ 24 to 72 h after onset; n =27）,and middle and late treatment group（ 72h after onset; n =19） according to the different timing of surgery. The prognosis of patients at 6 months after procedure was evaluated with the modified Rankin Scale（ mRS） scores. The differences of the rate of good prognosis（ mRS 0 to 2） and mortality in patients of the 3 groups were compared. Results（ 1） The ratios of good prognosis in the ultra-early treatment group,early treatment group,and middle and late treatment group were 55. 0%（ n = 22）,33. 3%（ n = 9）,and 21. 1%（ n = 4）,respectively. There were significant differences（ P 0. 05）. The mortality rate of the ultra-early treatment group（ 7. 5%） was lower than that of the early treatment group（ 25. 9%）or middle and late treatment group（ 42. 1%）. There were significant differences（ P 0. 05）.（ 2） There were significant differences in the rate of good prognosis in different timing of surgery in patients with gradeⅣ（ P 0. 05）; there was no significant difference in the rate of good prognosis in patients with grade Ⅴ（ P 0. 05）. The mortality ratios in patients of the 3 groups were 2 /18,4 /11,and 6 /11,respectively. There were significant differences（ P 0. 05）. Conclusion Ultra-early operation may benefit part of the patients with poor-grade aneurysm,particularly in patients with grade Ⅳ. As for the patients with grade Ⅴ,ultra-early operation may help to reduce short-term mortality rate,however,the rate of vegetative state is high.
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2015年第7期352-355,379,共5页
Chinese Journal of Cerebrovascular Diseases
关键词
颅内动脉瘤
蛛网膜下腔出血
高分级动脉瘤
手术时机
Intracranial aneurysm
Subarachnoid hemorrhage
Poor-grade aneurysm
Operation timing
