老年人颅内动脉瘤破裂出血早期外科治疗探析

Early Surgical Treatment for Elderly Patients with Intracranial Ruptured Aneurysms

目的:探讨老年人颅内动脉瘤破裂出血的病因及早期外科治疗方案。方法:回顾性分析67例60岁以上早期应用开颅手术夹闭动脉瘤颈或经血管内栓塞治疗老年人颅内动脉瘤破裂出血的临床资料及疗效。结果:22例开颅手术患者中,Hunt-Hess 1-3级17例,l6例取得了良好的预后,重残1例;Hunt-Hess 4-5级5例,3例取得了良好的预后,重残1例,死亡1例。45例栓塞治疗患者中,Hunt-Hess 1-3级33例,31例取得了良好的预后,重残1例,死亡1例;Hunt-Hess 4-5级12例,9例取得了良好的预后,重残1例,死亡2例。结论:在老年人颅内动脉瘤破裂出血患者中,Hunt-Hess 1-3级患者,预后良好,应早期积极行开颅手术或介入栓塞治疗;开颅手术与栓塞治疗在GOS无统计学差异,但栓塞治疗对患者创伤较少,在治疗老年患者中应首选。

Objective： To evaluate the early surgical treatment of ruptured intracranial aneurysms in elderly patients. Methods： Preoperatively, 67 cases were evaluated according to the treatment plan by clipping aneurysm or endovascular embolization in the early stage. Results：Of the 22 patients in the craniotomy group, 17 cases were Hunt-Hess grade 1 to 3, in which 1 6 cases had a good outcome and 1 case severe disability; 5 cases were Hunt-Hess grade 4 to 5, in which 3 cases had a good outcome, 1 case severe disability and 1 case died. And of the 45 patients in the endovascular embolization group, 33 cases were Hunt-Hess grade 1 to 3,in which 31 cases had a good outcome, 1 case severe disability and 1 case died; 12 cases were Hunt-Hess grade 4 to 5,in which 9 cases had a good outcome, 1 case severe disability and 2 cases died. had a worse outcome, including three deaths. Conclusion：With the early surgical treatment to ruptured intracranial aneurysms in elderly patients, the case was Hunt-Hess grade 1 to 3 had a good outcome. Surgical etilogical treatment plan including clipping aneurysm or endovascular embolization should be decided to performed in the early stage. And it was found that without statistics difference between the patients by clipping aneurysm or endovascular embolizadon in outcomes. The plan of endovascular embolization should be choose at first.