术前出血对脑动静脉畸形显微手术早期疗效的影响

Effect of presenting hemorrhage on early outcome after microsurgical resection of the cerebral arteriovenous malformations

目的探讨术前出血对脑动静脉畸形显微手术治疗早期疗效的影响。方法回顾性分析2000￣2005年采用显微手术治疗的101例脑动静脉畸形病人的临床资料,根据术前有无畸形血管团破裂出血将其分成颅内出血组和非颅内出血组;按照改良的Rankin量表分别在术前、出院时对患者的神经功能状态进行评分。采用χ2检验比较颅内出血组和非颅内出血组之间术后早期新的神经功能缺损发生率、早期疗效良好率。结果出血组18.8%(13/69)术后早期出现了新的神经功能障碍,非出血组50%(16/32)术后早期出现了新的神经功能障碍(P<0.05);早期疗效良好率颅内出血组为58.0%,非颅内出血组65.6%(P>0.05)。结论术前有颅内出血者较无颅内出血者术后少出现新的神经功能缺损,两组术后早期神经功能状态良好率无差别,颅内出血可能掩盖手术致残率。

Objective To investigate effect of presenting hemorrhage on early outcome after microsurgical resection of cerebral arteriovenous malformations （AVMs）. Methods The datas of 101patients with cerebral AVMs were analyzed retrospectively. Patients were examined by neurologists immediately before surgery and at discharge day. The functional neurological status was classified with the modified Rankin scale. All patients were divided into two groups according to the patients with ruptured AVMS or not at initial presentation. The Chi-square test was applied to test the effect of presenting hemorrhage on early outcome. Results Postoperatively, inhospital, 69 patients （69%） presented with hemorrhage, 13 patients （18.8%） showed new neurological deficits; 32 patients （31%）presented without hemorrhage, 16 patients （50%）showed new neurological deficits（P〈0.05）. Good outcomes were observed in 40 patients （58.0%） presented with hemorrhage, and in 20 patients（65.6%） presented without bemorrhage（P〉0.05）.Conclusion The findings suggest that The patients who presented with intracerebral hemorrhage have less new early neurological deficits than others who presented without intracerebral hemorrhage. Intracerebral hemorrhage may mask this surgical morbidity.