超早期行血管内栓塞术联合持续性腰大池引流术治疗高级别动脉瘤性蛛网膜下腔出血的预后分析

doi:10.3877/cma.j.issn.2095-9141.2018.05.003

目的

分析颅内囊状动脉瘤Hunt-Hess Ⅳ~Ⅴ分级患者超早期行血管内栓塞术联合持续性腰大池引流术的预后。

方法

回顾性分析大连大学附属中山医院神经外一科自2014年1月至2017年12月收治的颅内囊状动脉瘤Hunt-Hess Ⅳ~Ⅴ分级患者32例（Ⅳ级24例，Ⅴ级8例）的临床资料，其中16例超早期行血管内栓塞术联合持续性腰大池引流术（A组），另外16例患者入院超早期行血管内栓塞术（B组）；根据术后CT、TCD及临床症状，判断是否发生脑血管痉挛、脑积水及脑梗死，记录2组患者住院时间，对2组患者治疗后第1、3、6月的预后进行评价。

结果

A组发生脑血管痉挛5例、脑积水9例、脑梗死6例，住院时间（25±8）d；B组发生脑血管痉挛8例、脑积水11例、脑梗死9例，住院时间（28±9）d；2组比较差异有统计学意义（P<0.05）。2组治疗后1个月GCS评分比较，差异无统计学意义（P>0.05）；治疗后3、6个月改良Rankin量表评分比较，差异均有统计学意义（P<0.05）。

结论

颅内囊状动脉瘤Hunt-Hess Ⅳ~Ⅴ分级患者术后持续腰大池引流可减少脑血管痉挛、脑积水及脑梗死等并发症的发生，减少住院时间，提高患者术后3个月及半年恢复水平。

关键词: 高级别蛛网膜下腔出血, 颅内动脉瘤, 持续性腰大池引流术, 介入

Objective

To observe the prognosis of patients with Hunt-Hess grade Ⅳ-Ⅴ of intracranial saccular aneurysms who were treated with ultra-early emergency embolization and continuous lumbar drainage.

Methods

The clinical date of 32 patients with Hunt-Hess grade Ⅳ-Ⅴ intracranial saccular aneurysm (grade Ⅳ, n=24 and grade Ⅴ, n=8) admitted from January 2014 to December 2017 were analyzed retrospectively. Sixteen cases of them were treated with ultra-early emergency embolization and continuous lumbar drainage (group A) and 16 underwent emergency embolization (group B). The neurological prognosis of the patients was evaluated at 1, 3 and 6 months after treatment. According to head CT, TCD and clinical manifestation of postoperative patients, we determined whether there were cerebrovascular spasm, hydrocephalus and cerebral infarction, and counted the hospitalization time of the two groups.

Results

Group A has 5 patients with cerebral vasospasm, 9 patients with hydrocephalus, 6 patients with cerebral infarction and patients were in hospital for (25±8) d. Group B has 8 patients with cerebral vasospasm, 11 patients with hydrocephalus, 9 patients with cerebral infarction and patients were in hospital for (28±9) d. There was no significant difference in GCS between the group A and group B at 1 month after treatment (P>0.05); but there was significant difference in Rankin prognostic scores at 3 and 6 months after treatment between the 2 groups (P<0.05).

Conclusion

Ultra-early emergency embolization and continuous lumbar drainage can reduce the number of patients of cerebral vasospasm, hydrocephalus and cerebral infarction, and reduce the time of hospitalization, and improve the recovery level of 3 months and half a year after treatment.

Key words: High grade subarachnoid hemorrhage, Intracranial aneurysms, Continuous lumbar drainage, Interventional therapy

表1 高级别颅内动脉瘤患者一般状况

组别	例数	年龄（±s，岁）	动脉瘤瘤颈（±s，mm）	Hunt-Hess分级
组别	例数	年龄（±s，岁）	动脉瘤瘤颈（±s，mm）	Ⅳ级	Ⅴ级
A组	16	53±12	8.7±0.3	12	4
B组	16	54±11	8.4±0.6	12	4
t/χ²值	?	0.213	1.796	1	1
P值	?	0.732	0.086	0.352	0.352

表1 高级别颅内动脉瘤患者一般状况

组别	例数	年龄（±s，岁）	动脉瘤瘤颈（±s，mm）	Hunt-Hess分级
组别	例数	年龄（±s，岁）	动脉瘤瘤颈（±s，mm）	Ⅳ级	Ⅴ级
A组	16	53±12	8.7±0.3	12	4
B组	16	54±11	8.4±0.6	12	4
t/χ²值	?	0.213	1.796	1	1
P值	?	0.732	0.086	0.352	0.352

表2 2组颅内动脉瘤Hunt-HessⅣ~Ⅴ级患者治疗前后评分比较及住院时间比较（±s）

组别	例数	住院时间（d）	GCS评分		改良Rankin量表评分
组别	例数	住院时间（d）	术前	术后1个月	术后3个月	术后6个月
A组	16	25±8	3.8±1.3	3.7±1.4	3.0±1.2	2.4±1.2
B组	16	28±9	3.7±1.3	3.8±1.3	4.2±0.8	3.5±1.5
t值	?	?	0.218	0.210	3.324	2.287
P值	?	?	0.735	0.826	0.004	0.038

表2 2组颅内动脉瘤Hunt-HessⅣ~Ⅴ级患者治疗前后评分比较及住院时间比较（±s）

组别	例数	住院时间（d）	GCS评分		改良Rankin量表评分
组别	例数	住院时间（d）	术前	术后1个月	术后3个月	术后6个月
A组	16	25±8	3.8±1.3	3.7±1.4	3.0±1.2	2.4±1.2
B组	16	28±9	3.7±1.3	3.8±1.3	4.2±0.8	3.5±1.5
t值	?	?	0.218	0.210	3.324	2.287
P值	?	?	0.735	0.826	0.004	0.038

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Prognostic observation of ultra-early emergency embolizaltion and continuous lumbar drainage for high grade intracranial aneurysms

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Prognostic observation of ultra-early emergency embolizaltion and continuous lumbar drainage for high grade intracranial aneurysms