Hunt-Hess Ⅲ～Ⅳ级动脉瘤破裂病人不同时期血管内治疗刘玉和

OBSERVATION OF THE EFFECT OF HUNT-HESS GRADE Ⅲ～Ⅳ ANEURYSM TREATMENT WITH ENDOVASCULAR EMBOLIZATION IN DIFFERENT STAGE

目的:通过对102例Hunt-Hess Ⅲ～Ⅳ级动脉瘤破裂病人不同时期行血管内治疗的回顾性疗效分析,探讨治疗时间的选择对该类患者疗效的影响,为临床治疗提供参考。方法:回顾性分析102例Hunt-Hess Ⅲ～Ⅳ级动脉瘤破裂病例,其中急性期治疗组(治疗时间于发病后72h以内)63例,痉挛期治疗组(治疗时间于发病后3～14d)39例,通过比较二者在再出血率、术中动脉瘤破裂发生率、脑血管痉挛发生率、住院期间病死率、术后随访恢复良好率等方面的差异,探讨治疗时机的选择对患者预后的影响。结果:两组患者在再出血率、脑血管痉挛发生率、住院期间病死率方面,急性期治疗组明显低于痉挛期治疗组,术后随访恢复良好率明显优于对照组,差别均有统计学意义。术中动脉瘤破裂发生率方面二者无显著差别。结论:对Hunt-Hess Ⅲ～Ⅳ级动脉瘤破裂患者尽早实施血管内治疗,可降低患者再出血发生率,提高患者生存率,改善预后。

Objective ：To observe the therapeutic effect of the 102 patients who treated with Endovascular Embolization in different stage retrospectively. Methods.102 cases of aneurysmal subarachnoid hemorrhage of Hunt-Hess grade Ⅲ-Ⅳ were divided into two groups. 63 patients in acute stage treatment group were treated before onset 72h and 39 cases in vasospasm stage treatment group were treated after onset 3-14d. Then rehemorrhage rate, incidence rate of intraoperative aneurismal rupture, cerebral vasospasm, hospital mortality, and favorable rate of recovery between two groups were compared. Results ： Rehemorrhage rate, incidence rate of cerebral vaso-spasm and hospital mortality of patients in acute treatment group was obviously lower than control group ;favorable rate of recovery was higher;the difference between the two groups had statistic meaning. Incidence rate of intraoperative aneurismal rupture had no significant difference. Conclusion ： Active and effective endovascular embolization treatment for Hunt-Hess Grade Ⅲ-Ⅳ Aneurysm in acute Stage could obviously lower rehemorrhage rate while elevating survival rate, improving living quality.