不同处理方式对蛛网膜下腔出血预后的影响

Impact of Different Operation Methods on Subarachnoid Hemorrhage Prognosis

目的探讨开颅动脉瘤夹闭术和血管内栓塞治疗术对动脉瘤性蛛网膜下腔出血患者预后的影响。方法自2009年1～9月,连续入选在我院神经内科急诊就诊,发病72小时内明确诊断的动脉瘤蛛网膜下腔出血惠者,分为开颅动脉瘤央闭和血管内栓塞治疗两组,比较两组患者术后7d的美国国立卫生院神经功能缺损评分(National Institutes of Health Stroke Scale,NIHSS)、格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分和病死率,采用改良的Ranking量表(modified Ranking Scale,mRS)评定两组患者术后30d预后不良率。结果研究中共入选86倒患者,其中开颅动脉瘤夹闭术51例,血管内栓塞治疗术35例。两组术后7dNIHSS评分、GCS评分及病死率差异无统计学意义。开颅动脉瘤夹闭组治疗30d不良预后率(mRS>2分)高于血管内栓塞治疗组(35.3% vs 14.3%),差异有统计学意义(P=0.031)。结论动脉瘤性蛛网膜下腔出血后早期进行血管内栓塞治疗术的短期预后优于开颅动脉瘤夹闭术。

Objective To compare the short-term prognosis of endovascular coiling with neurosurgical clipping in anenrysmal subarachnoid hemorrhage. Methods We enrolled 86 patients with aneurysmal subarachnoid hemorrhage and assigned them to neurosurgical clipping group（n=51） or endovascular treatment group（n=35）. National Institutes of Health Stroke Scale（NIHSS）, Glasgow Coma Scale（GCS）, and mortality were assessed at 7 days after treatments, modified Ranking Scale（mRS） were assessed at 30 days after treatments. To compare the prognosis of the two groups. Results There were no significant differences of NIHSS, GCS and mortality at 7 days after treatments in neurosurgical clipping group and endovascular treatment group, but unfavorable prognosis rate（mRS〉2） in neurosurgical clipping group was higher than that in endovascular treatment group（35.3% vs 14.3%, P=0.031 ）. Conclusion Short-term prognosis of endovascular coiling was better than neurosurgical clipping in aneurysmal subaracbnoid hemorrhage patients.