摘要
目的探讨前循环破裂动脉瘤的手术适宜时机。方法回顾性分析82例前循环破裂动脉瘤患者，按入院时Hunt—Hess分级分为低分级组（Ⅰ～Ⅲ级，n=64）和高分级组（Ⅳ～Ⅴ级，n=18）；按手术时机分为早期手术组（≤3d，n=45）、中期手术组（4～10d，n=20）、晚期手术组（≥11d，n=12），5例因再出血未能手术。用格拉斯哥转归量表（GlasgowOutcomeScale，COS）评价转归。结果．在低分级患者中，早期手术组转归良好（GOS4～5分）率显著高于中、晚期手术组（96．3％对75％，P=0．031），而术后主要并发症发生率显著低于中晚期手术组（22．2％对46．9％，P=0．049）；中期手术组转归良好率显著高于晚期手术组（85．5％对41．7％，P=0．004），术后主要并发症发生率显著低于晚期手术组（30．0％对75．0％，P=0．027）。高分级患者均为早期手术，其转归良好率为55．6％。结论对不同分级的前循环破裂动脉瘤患者宜尽早手术。
Objeclive To investigate the appropriate timing of surgery for ruptured anterior circulation aneurysms. Methods Eighty-two patients with ruptured anterior circulation aneurysms were analyzed retrospectively. They were divided into the low-grade group （grade Ⅰ to Ⅲ, n =64） and the high-grade group （grade Ⅳ to Ⅴ, n = 18） according to the Hunt ＆ Hess scale on admission. Then they were also divided into early （ ≤ 3 d, n = 45 ）, intermediate （4- 10 d, n =20） and late （≥11 d, n = 12） surgery groups according to their timing of surgery. Surgery were not performed in 5 patients for rebleeding. The outcome at 3 months was scored according to the Glasgow Outcome Scale （GOS）. Results In the low-grade group, the rate of good outcome （GOS 4-5） in the early surgery group was significantly higher than that in the intermediate and late surgery groups （96.3% vs. 75.0%, P =0.031）, and the incidence of the major postoperative complications was significantly lower than that in the intermediate, and late surgery groups （22.2% vs. 46.9%, P =0. 049）; the rate of good outcome in the intermediate surgery group was significantly higher than that in the late surgery group （85.5% vs. 41.7%, P =0. 004）, and the incidence of the major postoperative complications was significantly lower than that in the late surgery group （30. 0% vs. 75.0%, P =0. 027）. The patients in the high- grade group were all operated early,＇ and their rate of good outcome was 55.6%. Conclmiom Early operation is advocated in patients with ruptured anterior circulation aneurysms of different grades.
出处
《国际脑血管病杂志》
北大核心
2010年第1期36-40,共5页
International Journal of Cerebrovascular Diseases
基金
江苏哲社会发展计划（BS2005023）
关键词
颅内动脉瘤
动脉瘤
破裂
手术
Intracrnnial aneurysms
Aneurysms, ruptured
Surgery
