摘要
目的观察比较血管内介入术和开颅夹闭术治疗颅内微小破裂动脉瘤的临床效果。方法抽取驻马店市中心医院2019年3月至2021年3月收治的颅内微小破裂动脉瘤患者68例,按随机数字表法分为介入组与开颅组,每组34例。开颅组采用开颅夹闭术,介入组采用血管内介入术。比较两组围术期情况、影像学指标、大脑中动脉(MCA)血流速度、颅内压、美国国立卫生院卒中量表(NIHSS)评分、简易智能精神状态检查量表(MMSE)评分、脑损伤指标、并发症。结果介入组术中出血量少于开颅组,手术时间、住院时间短于开颅组(P<0.05)。术后7 d,介入组动脉瘤瘤体高度和瘤颈长度之比(AR)、动脉瘤瘤体直径和载瘤动脉平均直径之比(SR)、入射角均低于开颅组(P均<0.05);术后7 d,介入组MCA血流速度、颅内压水平低于开颅组(P<0.05);术后3个月,介入组NIHSS评分低于开颅组,MMSE评分高于开颅组(P<0.05);术后24 h,两组神经元特异性烯醇化酶、星形胶质源性蛋白(S100B蛋白)均较术前增高,但介入组增高幅度低于开颅组(P<0.05);开颅组并发症发生率(17.65%,6/34)与介入组(2.94%,1/34)比较差异未见统计学意义(P>0.05)。结论与开颅夹闭术比较,血管内介入术治疗颅内微小破裂动脉瘤,可减轻患者脑组织损伤,改善脑组织血流和颅内压,并可改善神经功能及认知功能。
Objective To observe and compare the clinical effects of endovascular intervention and craniotomy clipping in the treatment of intracranial ruptured aneurysms.Methods A total of 68 patients with intracranial ruptured aneurysms treated in Zhumadian Central Hospital from March 2019 to March 2021 were selected and divided into intervention group and craniotomy group according to random number table method,with 34 cases in each group.The craniotomy group was treated by craniotomy clipping,and the intervention group was treated by endovascular intervention.The perioperative conditions,imaging indexes,blood flow velocity of middle cerebral artery(MCA),intracranial pressure,National Institutes of Health Stroke Scale(NIHSS)score,Mini-Mental State Examination(MMSE)score,brain injury indexes and complications were compared between the two groups.Results The intraoperative blood loss in the intervention group was less than that in the craniotomy group,and the operation time and hospital stay were shorter than those in the craniotomy group(P<0.05).Seven days after operation,aspect ratio of tumor height to length(AR),size ratio of major diameter of aneurjsm to average diameter of parent artery(SR),and incident angle in the intervention group were lower than those in the craniotomy group(all P<0.05).Seven days after operation,the MCA blood flow velocity and intracranial pressure in the intervention group were lower than those in the craniotomy group(P<0.05).Three months after operation,the intervention group had lower NIHSS score and higher MMSE score,compared with the craniotomy group(P<0.05).Twenty-four hours after operation,neuron-specificenolase and S100B proteins in both groups were increased,compared with those before operation,but the increase in the intervention group was lower than that in the craniotomy group(P<0.05).There was no significant difference in the incidence of complications between the craniotomy group(17.65%,6/34)and the intervention group(2.94%,1/34),P>0.05.Conclusions Compared with craniotomy clipping,endovascular intervention in the treatment of patients with intracranial ruptured aneurysms can reduce brain tissue damage,improve brain tissue blood flow and intracranial pressure,and improve neurological function and cognitive function.
作者
冯文献
刘丹
张昊
杨扬
李力
王纵
Feng Wenxian;Liu Dan;Zhang Hao;Yang Yang;Li Li;Wang Zong(Stroke Center,Zhumadian Central Hospital,Zhumadian 463000,China;Department of Neurology,Zhumadian Central Hospital,Zhumadian 463000,China;Department of Neurosurgery,Zhumadian Central Hospital,Zhumadian 463000,China)
出处
《中国实用医刊》
2022年第15期29-32,共4页
Chinese Journal of Practical Medicine
关键词
颅内动脉瘤
血管内介入术
开颅夹闭术
Intracranial aneurysm
Endovascular intervention
Craniotomy clipping
