老年人动脉瘤性蛛网膜下腔出血早期介入治疗的临床研究

Clinical study of early intervention treatment of aneurysmal subarachnoid hemorrhage in the elderly

目的探讨老年人动脉瘤性蛛网膜下腔出血早期介入栓塞治疗的安全性和可行性。方法84例经CT明确的蛛网膜下腔出血的60岁以上的患者，Hunt＆Hess分级为Ⅱ级26例，Ⅲ级31例．Ⅳ级25例，Ⅴ级2例。出血后6～72h内，经全脑血管造影共发现89个动脉瘤，立即行介入栓塞治疗，根据动脉瘤结构。分别采用单纯弹簧圈栓塞、球囊辅助技术和支架结合技术栓塞。术后给予脱水、扩容、扩血管、腰穿及（或）间断腰大池引流，同时对并存疾病予以治疗。结果89个动脉瘤，成功栓塞83个，技术成功率93．3％。术后3个月格拉斯哥预后评分（GOS）优良68例，中残7例，重残4例．死亡5例（与技术相关的死亡1例）；结论老年动脉瘤性蛛网膜下腔出血患者，并存症多、全身状况较差，介入栓塞为一种安全、有效的治疗手段。

Objective To investigate the safety and feasibility of early intervention treatment for aneurysmal subaraehnoid hemorrhage in the elderly. Methods Within 6 to 72 hours after hemorrhage, 89 aneurysms were detected by overall brain angiogram in 84 elderly patients （aged above 60 years） Who were diagnosed as subaraehnoid hemorrhage on CT. HUNT-HESS grade was as following： 26 cases of grade Ⅱ , 31 cases of grade Ⅲ , 25 cases of grade Ⅳ , 2 cases of grade V. Interventional embolization treatment was performed immediately. According to the structure of the aneurysm, pure coil embolization, balloon assisted technique and combined with stent technique were performed. Anhydration, fluid expansion, vessel dilatation, lumbar puncture and/or lumbar drainage were performed after procedure. At the same time, the complications were treated. Results Eighty-three aneurysms were embolized successfully in 89 patients. The success rate of the technique was 93. 3%. The Glasgow Outcome Scale （GOS） score at 3 months post procedure showed a good result in 68 patients, medium disability in 7 patients, severe disability in 4 patients, death in 5 patients （1 case was related to the technique）. Conclusions Interventional embolization is a safe and effective therapeutic approach in elderly patients with subarachnoid hemorrhage.