不同时间实施颅内动脉瘤显微外科手术对患者的临床疗效及预后的影响

Effect of microsurgical treatment of intracranial aneurysms at different time on clinical efficacy and prognosis

目的探讨不同时间实施颅内动脉瘤显微外科手术对患者的临床疗效及预后的影响。方法选取2016年3月~2019年3月期间收治的颅内动脉瘤患者90例为研究对象,随机分为观察组、对照组,每组各45例。两组患者均进行显微外科手术治疗,观察组患者在手术时间至发病时间3 d内进行手术,对照组在手术时间至发病时间≥7d时进行手术。对两组患者的手术效果、并发症发生率、生活质量评分、认知功能评分、血清因子等进行统计对比。结果观察组、对照组手术优良率分别为91.11%(41/45)、75.56%(34/45)(P<0.05)。观察组、对照组术后并发症发生率分别为6.67%(3/45)、22.22%(10/45),观察组低于对照组,组间有统计学差异(P<0.05)。在认知功能评分比较中,观察组术后简易智力状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分高于对照组(P<0.05)。术后观察组患者心理功能、生理功能、日常活动、社交功能等各项生活质量评分均高于对照组(P<0.05)。在血清学指标对比中,术后观察组的基质金属蛋白酶-9 (MMP-9)、髓过氧化物酶(MPO)、神经烯醇化酶(NSE)水平均低于对照组(P<0.05)。结论手术时机的选择对于颅内动脉瘤显微外科手术患者的手术效果有一定的影响,患者尽早的开展早期手术治疗能够进一步提高患者的手术治疗效果,降低并发症发生率,改善患者的术后认知功能和生活质量评分及血清学指标,值得临床推荐。

Objective To study the effect of microsurgery of intracranial aneurysms at different time on clinical efficacy and prognosis.Methods Ninety patients with intracranial aneurysms admitted to our hospital from March 2016 to March 2019 were randomly divided into observation group and control group,45 cases in each group.Both groups were treated with microsurgery.The patients in the observation group were operated within 3 days from the operation time to the onset time,while those in the control group were operated from the operation time to the onset time(> 7 days).The operation effect,complication rate,quality of life score and cognitive function score were compared between the two groups.Results The excellent and good rates of operation in the observation group and the control group were 91.11%(41/45) and 75.56%(34/45),respectively(P<0.05).The incidence of postoperative complications in the observation group and the control group was 6.67%(3/45) and 22.22%(10/45),respectively,which was lower than that in the control group(P<0.05).The scores of MMSE and MOCA in the observation group were higher than those in the control group(P<0.05).The scores of psychological function,physiological function,daily activity and social function in the observation group were higher than those in the control group(P<0.05).The levels of MMP-9,MPO and NSE in the observation group were lower than those in the control group(P<0.05).Conclusion Operative timing has a certain impact on the outcome of microsurgery for intracranial aneurysms.Early surgical treatment can further improve the outcome of surgery,reduce the incidence of complications and improve the cognitive function and quality of life score of patients.It is worthy of clinical recommendation.