摘要
目的：探讨介入治疗时机对于高分级颅内动脉瘤破裂患者栓塞术后并发症发生率及预后的影响。方法回顾性分析2008年1月至2012年12月接受介入栓塞术后的200例高分级（ Hunt-Hess Ⅳ、Ⅴ级）颅内动脉瘤破裂患者资料，经筛选最后入组病例数为162例。所有患者均术前先行颅脑CT平扫明确自发性蛛网膜下腔出血，并行头颅CTA或DSA检查证实。入组患者除外既往有严重的神经系统疾病、昏迷、终末期疾病患者。根据患者接受介入治疗时机分为早期治疗组（发病时间＜72 h）79例与延期治疗组（发病时间≥72 h）83例。术后通过格拉斯哥昏迷评分（GCS）、出院格拉斯哥预后评分（GOS）及出院后3个月巴塞尔指数（BI）对患者预后进行评估，并统计并发症的发生情况。2组间评分比较采用独立样本t检验；计数资料间比较采用χ2检验；介入时机与预后的相关性应用二元Logistic回归分析。结果早期治疗组与延期治疗组术后GCS评分分别为（6.6±1.6）、（6.1±1.4）分，出院时GOS评分分别为（3.0±0.7）、（2.9±0.7）分，2组间差异无统计学意义（ t值分别为1.822、0.631，P值均＞0.05）。而早期治疗组患者在出院3个月后BI（63.5±13.5）明显好于延期治疗组（34.8±12.7），差异有统计学意义（ t＝6.127，P＜0.05），且早期治疗组术后发生脑积水6例、下肢静脉血栓5例，明显少于延期治疗组（分别为18、15例），差异有统计学意义（χ2值分别为6.369、5.158，P值均＜0.05）。早期介入治疗可有效改善患者预后（ OR＝3.897，P＝0.009）。结论对于高分级颅内动脉瘤破裂患者，早期介入治疗对于患者长期预后有明显改善，且可以减少术后并发症的发生。选择合适的治疗时机对颅内动脉瘤破裂患者预后存在积极意义。
Objective To evaluate prognostic effects and complications of interventional embolization at different time points on patients with ruptured intracranial aneurysms of Hunt -Hess Ⅳ-Ⅴlevels.Methods Through a retrospective analysis from 2008.1 to 2012.12, we collected 162 from 200 patients who underwent interventional embolization due to ruptured intracranial aneurysms according to the criteria.Patients with serious neurological disorders , coma, and end-stage diseases were excluded.Brain CT scan was performed to identify the spontaneous subarachnoid hemorrhage of the patients , followed by CTA or digital subtraction angiography （ DSA） to ensure the accurate diagnosis of intracranial aneurysms.All of the patients at Hunt-HessⅣ-Ⅴlevels were treated with interventional embolization , and were divided into two study groups：early stage therapy group of 79 patients （ embolization at the time 0.05）.The early therapy group also presented a significant decrease of complications , such as hydrocephalus （χ2 =6.369, P〈0.05 ） and venous thrombosis （χ2 =5.158, P 〈0.05 ）, compared to the late therapy group.Furthermore, Statistical analysis revealed that therapeutic time closely correlated with the prognosis of patients with ruptured intracranial aneurysms at Hunt-Hess Ⅳ-Ⅴ levels （ P =0.009, OR =3.897）.Conclusion The early stage therapy can improve the prognosis and decrease incidence of complications , which should benefit the efficient management of the patients with interventional embolization of ruptured intracranial aneurysms.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2014年第6期492-495,共4页
Chinese Journal of Radiology
关键词
颅内动脉瘤
栓塞
治疗性
手术后并发症
预后
Intracranial aneurysm
Embolization,therapeutic
Postoperative complications
Prognosis
