动脉瘤性蛛网膜下腔出血患者早期栓塞治疗的疗效分析

Curative effect analysis of aneurysmal subarachnoid hemorrhage in early embolization therapy

目的 对动脉瘤性蛛网膜下腔出血(aSAH)患者早期栓塞治疗的疗效及并发症进行分析.方法 对2009年12月至2011年10月在沂水中心医院神经科住院的、发病3d以内的96例aSAH患者根据Hunt-Hess分级情况,分为Ⅰ～Ⅲ组(85例)和Ⅳ～Ⅴ组(11例),两组患者均采用微弹簧圈进行囊内栓塞,术后给予腰椎穿刺脑脊液置换、扩容和提高血压等治疗,术后3个月对患者进行脑CT及DSA随访,以观察治疗效果及术中、术后并发症.所得结果用SPSS 17.0软件进行统计学处理,各组患者的栓塞程度及治疗结果比较采用x2检验.结果 接受治疗的96例aSAH患者中,HuntHess分级:Ⅰ级21例,Ⅱ级36例,Ⅲ级28例,Ⅳ级6例,Ⅴ级5例,共死亡4例,死亡率4.2％；动脉瘤瘤腔100％栓塞者88例、95％栓塞者5例、90％栓塞者3例.术中动脉瘤破裂出血4例,脑血管痉挛(CVS)5例,脑梗死1例,死亡4例.全组与介入治疗相关的并发症10例,除死亡病例外,无aSAH相关性永久性后遗症；与aSAH相关的并发症有脑梗死8例,脑积水11例,均经腰椎穿刺脑脊液置换、扩容和提高血压等治疗后缓解.Hunt-Hess分级Ⅰ～Ⅲ级组与Ⅳ～Ⅴ组比较,治疗效果与并发症均无统计学差异(x2=0.540,x2=0.490,P＞0.05).结论 早期(3d内)的介入治疗及妥善的术后处理是预防aSAH患者再出血和减少并发症的关键.

Objective To analyze the early embolization treatment efficacy and complications of the aneurysm subarachnoid hemorrhage( aSAH). Methods Nintey-six patients were divided into group Ⅰ ~ Ⅲ( 85 cases) and group Ⅳ ~ Ⅴ( 11 cases) according to Hunt-Hess grade,microcoil was utilized for early intracapsular embolization in 96 aSAH patients diagnosed within 3 days in department of neurology from Yishui central hospital from December 2009 to October 2011. The exchang of cerebrospinal fluid,dilatation,elevate blood pressure were done early after operation. Patients were followed up by CT and DSA 3 months after operation,the treatment results and the complications were observed in and after operation. The extent of occlusion and treatment outcomes of patients in each group were compared by the χ2test. Results According to Hunt-Hess grade,there were 21 cases in grade Ⅰ,36 cases in grade Ⅱ,28 cases in grade Ⅲ,6 cases in grade Ⅳ,5 cases in grade Ⅴ,4 cases were died,the mortality rate were 4. 2%. All of 96 aSAH cases were successfully embolized,among them,88 cases aneurysm cavity were 100% occluded,5 cases were 95%occluded,3 cases were 90% occluded. Four cases occurred intraoperative aneurysms rupture,5 cases occurred intraoperative cerebral vasospasm,1 case occurred cerebral infarction and 4 cases died interoperation. Ten cases occurred interventional treatment-related complications,in addition to deaths; No cases occurred permanent sequelae of aSAH-related. The aSAH-related complications included 8 cerebral infarction,11 hydrocephalus were all cured after the treatment of exchang of cerebrospinal fluid,dilatation,elevate blood pressure. There were no statistical differences in treatment effects and complications between grade Ⅰ-Ⅲ and grade Ⅳ-Ⅴ( χ2= 0. 540,χ2= 0. 490,P > 0. 05). Conclusion Early treatment in 3 days with interventional therapy and management of post-operative complications in aSAH is very important. It is the key to prevent rebleeding and reduce the complications.