动脉瘤性蛛网膜下腔出血后不同治疗方式对分流依赖性脑积水的影响

摘要

Objective To compare the influences of microsurgical clipping and endovascular embolization treatment on shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH), and explore the high risk factors for shunt-dependent hydrocephalus. Methods Clinical data of 266 patients with aSAH were analyzed retrospectively, and the patients were divided into clipping group (n=164 ) and embolization group ( n = 102 ) according to the different surgical methods . Then , 37 patients who needed to perform ventriculoperitoneal shun served as shunt group, and the other patients as non-shunt group. The clinical data in two groups were analyzed statistically. Results No significant difference in the incidence of shunt-dependent hydrocephalus was observed between clipping group and embolization group ( P > 0 . 05 ) . There were significant differences in age , Hunt-Hess grade , Fisher grade and intraventricular hemorrhage between shunt group and non-shunt group (P<0.05), while there were no significant differences in the incidence of acute hydrocephalus and location of aneurysm (P>0.05). With logistic regression analysis, the independent risk factors for shunt-dependent hydrocephalus after aSAH were as follows: equal or older than 65 years, Hunt-Hess grade Ⅳ or Ⅴ, Fisher grade Ⅲ or Ⅳ and intraventricular hemorrhage. Conclusions There is no significant difference in the incidence of shunt-dependent hydrocephalus between microsurgical clipping and endovascular embolization in patients with aSAH. The patients with advanced age, poor initial neurological status and intraventricular hemorrhage are more easier to occur shunt-dependent hydrocephalus, to which more attention needs to be given.%目的比较开颅夹闭和血管内栓塞对动脉瘤性蛛网膜下腔出血(aSAH)术后发生分流依赖性脑积水的影响，探讨分流依赖性脑积水的高危因素。方法回顾性分析266例aSAH病人的临床资料，按治疗方式不同分为开颅夹闭组(164例)与血管内栓塞组(102例)。并将术后需行脑室-腹腔分流术的37例作为分流组，其他作为非分流组，对两组资料进行统计分析。结果开颅夹闭组和血管内栓塞组分流依赖性脑积水的发生率无明显差异(P＞0.05)。分流组与非分流组在年龄、Hunt-Hess分级、Fisher分级、伴脑室内出血方面差异有统计学意义(P＜0.05)，而两组在发生急性脑积水及动脉瘤部位方面的差异无统计学意义(P＞0.05)。经Logistic回归分析：年龄≥65岁、Hunt-HessⅣ~Ⅴ级、FisherⅢ~Ⅳ级、伴脑室内出血是发生分流依赖性脑积水的独立危险因素。结论对aSAH病人采取开颅夹闭或血管内栓塞术后，发生分流依赖性脑积水的情况并无差异；高龄、较差的起始神经系统状态及伴有脑室内出血的aSAH病人更易发生分流依赖性脑积水，应引起临床注意。