Objective To investigate the effect of microsurgical clipping on postoperative complications and prognosis of patients with high grade anterior communicating aneurysms.Methods 60 patients of Hunt-Hess Ⅲ~Ⅳ from January 2012 to May 2017 were analyzed respectively after microsurgical clipping surgery for patients with grade IV clinical communicating artery aneurysm. According to onset time from the operation time,the cases were divided into 30 of early group(0-3) and 30 of late group(more than 8).The age,preoperative Fisher classification and some other data of the two groups of patients were counted.Results There was no significant difference in the average age and postoperative venous thrombosis of the lower extremities in the two groups(all P>0.05). Two groups of preoperative Fisher grading,postoperative intracranial hematoma,hydrocephalus, delayed ischemic nerve dysfunction,pulmonary infection,postoperative cognition,behavioral defects and discharge outcome prognosis rate had significant differences(P<0.05-0.01).Conclusion Early operation of high grade anterior communicating aneurysm can effectively reduce postoperative complications,and the postoperative outcome is better than that of late operation.%目的 探讨显微夹闭手术时机对高分级前交通动脉瘤患者术后并发症和预后的影响.方法 回顾性分析2012年1月至2017年5月行显微夹闭手术治疗,符合纳入标准的60例Hunt-HessⅢ~Ⅳ级前交通动脉瘤患者的临床资料.按照患者手术时间距发病的时间,分为早期组(0~3 d,30例)和晚期组(≥8 d,30例)两个亚组.分析两组患者的年龄、术前Fisher分级和术后并发脑内血肿、脑血管痉挛引起的迟发性缺血性神经功能缺损、肺部感染、脑积水、下肢静脉血栓、认知行为障碍的发生率及出院时预后良好率.结果 两组患者的平均年龄、术后并发下肢静脉血栓比较,差异无统计学意义(均P>0.05).两组术前Fisher分级、术后并发颅内血肿、脑积水、迟发性缺血性神经功能缺损、肺部感染、认知行为障碍及出院预后良好率比较,差异均有统计学意义(P<0.05~0.01).结论 高分级前交通动脉瘤早期手术能有效地减少术后并发症,且预后要优于晚期手术.
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