破裂动脉瘤早期显微手术结合抗血管痉挛药物治疗的疗效分析

Outcomes of early surgery combined with anti-vasospasm agents treat ruptured cranial aneurysms： an analysis of 127 cases

目的总结动脉瘤破裂蛛网膜下腔出血早期（3d内）显微手术结合抗痉挛药物治疗的效果和经验，探讨及评估早期手术治疗的方法和价值。方法经脑血管造影（DSA）及CT血管成像（CTA）确定动脉瘤破裂蛛网膜下腔出血（SAH）的患者共127例，行早期显微手术夹闭动脉瘤，结合抗痉挛药物治疗，分析其临床表现，影像学特点，早期手术治疗的手术入路选择、术中操作方法和技巧及药物对症治疗等综合处理后的疗效、经验和体会。结果127例病人术中探查均见蛛网膜下腔出血及脑血管痉挛、破裂动脉瘤周围有机化血凝块，在分离瘤颈中有21例动脉瘤破裂出血；按格拉斯哥预后评分（GOS），术后治愈或好转109例，其中术后有一过性偏瘫或原有偏瘫加重23例、其中出院时明显好转18例，轻度残废9例，重度残废6例，死亡3例。结论早期手术能有效防止动脉瘤再次破裂出血、降低死亡率、减轻血管痉挛发生率及后续损害，血管痉挛发生仍是早期动脉瘤破裂蛛网膜下腔出血的严重并发症，抗痉挛药物术中、后的恰当使用，对预防脑血管痉挛及保护脑功能等方面能起到较好的疗效。

[ Abstract] Objective Retrospective study on 127 cases of early microsurgery combined with antivasospasm agents for treatment of subaraehnoid hemorrhage after the rupture of intracranial aneurysm. To evaluate the microsurgery for early-stage （3 days ） of ruptured aneurysm. Methods 127 cases of subaraehnoid hemorrhage after the rupture of intraeranial aneurysm were diagnosed by MRI and CTA. Patients underwent early microsurgical clipping of intracranial aneurysm followed by antivasospasm agents treatment were retrospectively analyzed for their clinical manifestation, characteristics of imaging presentation, the curative effects and experiences of different operative approaches, surgical methods and techniques, pharmaceutical treatment and other integrated management. Results In all 127 cases, organized blood clot accompanied with subaraehnoid hemorrhage and cerebral vasospasm surrounding the ruptured aneurysm was found in the course of surgical probing, among which 21 aneurysms ruptured during the operation; according to the GOS , 109 cases were cured or free of symptom, 23 cases got a transient hemiparalysis or aggravation of hemipralysis, among which 18 cases were free of symptom, 9 were slight disability, 6 were severe disability, 3 eases die when discharged. Conclusions Early operation could prevent second-time rupture effectively, lower the death rate, and at the same time lower the occurrence of cerebral vasospasm and the succeeding damage caused. Cerebral vasospasm is still the serious complication of subarachnoid hemorrhage of ruptured aneurysm and inappropriate management would cause critical consequences. Antivasospasm agents used postoperative could help preventing cerebral vasospasm and maintaining function.