颅内破裂动脉瘤手术时机的选择及预后相关性研究

摘要

ObjectiveTo discuss the individualized option on surgical timing of ruptured intracranial aneurysm and the relationship with clinical prognosis.Methods To reviewing and analyzing 52 cases of ruptured intracranial aneurysm from 2011-2015 in our department. 42 cases were under sugical treatment. The patients were divided into group A(30 cases of I-III grade)and group B(12 cases of IV-V grade)based on Hunt-Hess;into early stage team(1-3days)with 19 cases and advanced stage team(4-14days)with 23 cases. Furthermore,the patients’ neurological function were marked based on Glasgow Outcome Scale(GOS). Enventually,the comparison and statistical analysiswere conducted on the major complication such as cerebral vasospasm,hydrocephalus and epilepsy.Results The GOS showed the following postoperation outcome:31 cases were under good recovery,5 cases were moderate disabled but life-independent,3 cases were serious disabled and life-dependent,3 cases were operative death,the best operation outcomes were effected by early surgery. The occurrence rate of post-operation cerebral vasospasm was 10.5% in early stage team and was 26.1% in advanced stage team respectively. The occurrence rate of hydrocephaluswas 15.8% in early stage team and 21.7% in advanced stage team. The occurrence rate of epilepsy was 5% in early stage team and 17.4% in advanced stage team.Conclusion The best sugery outcome is affected by early operation,and it can reduce the main post-operation complication. In terms of the ruptured intracranial aneurysm patient in different stage,an early operation is suggested based on the condition of the hospital and the individual.%目的：探讨颅内破裂动脉瘤手术时机的个体化选择和临床预后的相关性。方法2011年至2015年52例颅内破裂动脉瘤患者，其中42例进行手术治疗，入院时按Hunt-Hess分级分为A组（Ⅰ~Ⅲ级30例），B组（Ⅳ~Ⅴ级12例），按手术时机分为早期组（1~3d）19例，晚期组（4~14d）23例，以格拉斯哥转归评分量表（GOS）对患者神经功能进行评分，对主要并发症脑血管痉挛、脑积水、癫痫进行比较和统计学分析。结果术后1个月GOS评分，恢复良好31例，中度病残但生活自理5例，重度病残生活不能自理3例，死亡3例，手术效果以早期手术最佳。术后脑血管痉挛发生率早期组10.5%，晚期组26.1%；脑积水发生率早期组为15.8%，晚期组为21.7%，癫痫发生率早期组为5%，晚期组为17.4%。结论手术效果以早期手术为最佳，能降低术后手术的主要并发症，对不同级别的颅内破裂动脉瘤患者，应根据医院和个人条件，尽早手术。