摘要
目的探讨颅内破裂动脉瘤手术时机与临床预后的关系。方法回顾性分析2005年我院收治的237例颅内破裂动脉瘤,其中196例行手术治疗。按入院时Hunt-Hess分级将手术病人分为A组(Ⅰ～Ⅲ级)162例,B组(Ⅳ、Ⅴ级)34例;根据手术时间分为早期手术组(SAH3d内手术)19例,延期手术组(SAH4～10d手术)82例,晚期手术组(SAH11d之后手术)95例。比较不同手术期别动脉瘤术中破裂率、术后1个月GOS评分及术后主要并发症(脑血管痉挛、脑积水)发生率,并进行统计学分析。结果24例(10.1%)因再出血丧失治疗机会。术中动脉瘤破裂早期手术组3例(15.8%),延期手术组8例(9.8%),晚期手术组6例(6.3%)。术后脑血管痉挛发生率早期手术组为15.8%,延期手术组为19.5%,晚期手术组为17.9%。脑积水发生率以晚期手术组最高(14.7%)。对术后1个月GOS评分Ridit分析结果显示:A、B两组中均以早期手术组治疗效果最佳,延期手术次之,晚期手术最差。结论早期手术可规避颅内破裂动脉瘤再出血的风险,降低主要并发症发生率。对于各个级别(包括Ⅳ、Ⅴ级)的SAH病人,均应根据治疗者的手术经验与技巧和所在医院的条件,及早诊断,尽早手术。
Objective To investigate the correlation between surgical timing and clinical prognosis. Methods The data from 237 cases of ruptured intracranial aneurysm admitted in our hospital in 2005 was retrospectively analyzed, of them 196 were operated on and divided into group A （grades Ⅰ to Ⅲ, n=162） and group B （grades Ⅳ to Ⅴ, n=34） according to Hunt-Hess grade when admitted. Each group was then divided into early surgery group （SAH 〈72 h）, intermediate surgery group （SAH 4-10 d） and late surgery group （SAH 〉11d） based on the surgical timing. The rate of intraoperative rupture of the aneurysms, incidence rate of the main complications （cerebral vasospasm, hydrocephalus） and GOS one month after surgery were statistically compared between the groups. Results Twenty-four cases （10.1%） lost the opportunity for further treatment because of rebleeding. Intraoperative rupture of the aneurysm was encountered in 3 cases （15.8%） of the early surgery group, 8 （9.8%） in the intermediate group and 6 （6.3%） in the late surgery group. The morbidity of postoperative cerebral vasospasm was 15.8% in the early surgery group, 19.5% in the intermediate surgery group, and 17.9% in the late surgery group, while the morbidity of hydrocephalus in the late surgery group was the highest （14.7%）. The Ridit analysis of GOS 1 month after the surgery revealed that the outcome was best in early surgery group, no matter the Hunt-Hess grade was high or low. Conclusion The early surgery could avoid the risk of aneurysmal re-rupture and decrease the morbidity of the main complications. All spontaneous subarachnoid hemorrhage patients, no matter what Hunt-Hess grade classification is, should be diagnosed and treated as quickly as possible according to the neurosurgeons＇ experience and the condition of the hospital.
出处
《中国微侵袭神经外科杂志》
CAS
2007年第5期199-201,共3页
Chinese Journal of Minimally Invasive Neurosurgery
关键词
颅内动脉瘤
动脉瘤
破裂
蛛网膜下腔出血
手术时机
intracranial aneurysm
aneurysm, ruptured
subarachnoid hemorrhage
operation timing
