不同手术时机对动脉瘤性蛛网膜下腔出血患者迟发性脑缺血的影响

摘要

目的：探讨不同手术时机对动脉瘤性蛛网膜下腔出血患者迟发性脑缺血（ DCI）的影响。方法收集动脉瘤性蛛网膜下腔出血患者136例作为研究对象，根据不同手术时机分为早期组（发病后﹤3 d）40例，延期组（发病后﹥3 d）96例。所有患者均采用动脉瘤颈夹闭手术治疗，比较两组患者发病后不同时间点（3 d、5 d、7 d、10 d）的血白介素6（IL -6）、白介素1β（IL -1β）和肿瘤坏死因子（TNF -α）的变化、DCI 发生及神经功能恢复情况。结果早期组患者 IL -6、IL -1β和 TNF -α水平在发病后﹤5 d 逐渐升高，发病后7 d 开始下降，发病后10 d 接近发病后3 d 的水平（ P﹤0.05）；延期组患者 IL -6、IL -1β和 TNF -α水平在发病后﹤7 d 逐渐升高，发病后10 d 开始下降。早期组 IL -6、IL-1β和 TNF -α水平在发病后5 d、7 d、10 d 均明显低于延期组（ P ﹤0.05）。早期组 DCI 发生率明显低于延期组（ P ﹤0.05），早期组神经功能改善程度明显优于延期组（ P ﹤0.05）。结论早期手术治疗动脉瘤性蛛网膜下腔出血能有效降低患者血清炎性细胞因子水平，减轻炎症反应，降低 DCI 的发生率，从而改善患者的神经功能，提高临床疗效。%Objectine To explore the significance of different operating timing in treatment of delayed cerebral ischemia(DCI)in patients with aneurysmal subarachnoid hemorrhage. Methods A total of 136 patients with aneurysmal subarachnoid hemorrhage were collected in this study,they were divided into early group(after the onset of disease ﹤ 3 days,n = 40 cases)and delayed group(after the onset of disease ﹥ 3 days,n = 96 cases)according to different operating time. All these patients were treated by aneurysm neck clipping operation,the changes in blood levels of interleukin - 6(IL - 6),IL - 1β and tumor necrosis factor(TNF) - α at different time points after the onset of disease,and the occurrence of DCI and the recovery of nerve function were compared between these two groups. Results The blood levels of IL - 6,IL - 1β and TNF - α at ﹤ 5 days after the onset of disease were gradually increased in patients of early group,they started to decrease at 7 days after the onset of disease,and they were close to the 3 daysˊlevel at 10 days after the onset of disease( P ﹤ 0. 05). The levels of IL - 6,IL - 1β and TNF - αwere gradually increased in delayed group at ﹤ 7 days after the onset of disease,and they started to decline at 10 days after the onset of disease ( P ﹤ 0. 05). The blood levels of IL - 6,IL - 1β and TNF - α at 5 days,7 days and 10 days after the onset of disease in early group were signifi-cantly lower than those in delayed group( P ﹤ 0. 05). The incidence of DCI in early group was significantly lower than that of delayed group( P﹤ 0. 05). The improvement of nerve function in early group was significantly better than that of delayed group( P ﹤ 0. 05). Conclusion The treatment of aneurysmal subarachnoid hemorrhage with early operation can effectively reduce the serum levels of inflammatory cytokines,remit of inflammation,and reduce the incidence of DCI,so as to improve the nerve function of patients and improve their clinical curative effect.