前循环破裂动脉瘤老年病人的手术治疗

Surgical treatment of ruptured anterior circulation aneurysms in elders

目的探讨年龄／〉60岁前循环颅内破裂动脉瘤病人手术治疗的相关问题。方法回顾性分析2009至2012年山东大学第二医院显微手术治疗的年龄≥60岁前循环颅内破裂动脉瘤病人，共38例的临床资料。分析其出院（近期）、出院后半年（远期）mRS（ModifiedRankinScale）评分，探讨老年前循环颅内破裂动脉瘤的手术适应证、手术时机、术后并发症等问题。38例中Hunt—Hess分级I级6例，Ⅱ级17例，Ⅲ级5例，Ⅳ级6例，V级4例。术前患有其他器官疾病者33例，另外5例既往体健，其H—H分级分别是Ⅱ级1例，Ⅲ级3例，Ⅳ级1例。结果出院时38例病人mRS评分0、1、2、3、4、5及6分者分别为12、10、4、3、3、4及2例；随访时mRS评分0、1、2、3、4、5及6分者分别为12、10、4、1、3、3及3例；5例既往体健病人出院及随访时mRS评分都在0～2分。结论手术是挽救该类病人生命甚至达到良好恢复的重要方法。年龄并不是造成老年颅内动脉瘤手术预后不佳的危险因素；没有明显的手术禁忌者应该积极的早期手术治疗。在决定手术时其生理状况比年龄更为重要。

Objective To explorc some related problems in surgical treatment of ruptured anterior circulation intracranial aneurysms in elders. Methods The clinical data of 38 elderly patients with ruptured anterior circulation intracranial aneurysms were analyzed retrospectively. Such related problems as indication, timing and complications of operation were discussed through their Modified Rankin scales at discharge and half a year later. Results Their Hunt-Hess grades were I （n =6）, IX （n = 17）, m （n =5）, IV （n =6） and V （ n = 4 ） respectively. Among them, 33 cases were complicated preoperatively with other vital diseases while another 5 previously healthy （]]I, n = 3 ; 11 , n = 1 ; IV, n = 1 ）. And their modified Rankin scales of discharge and half-a-year follow-up were 0 （n = 12 vs 12）, 1 （n = 10 vs 10）, 2 （n =4 vs 4）, 3 （n =3 vs 1）,4 （n=3 vs3）, 5 （n=4 vs 3） and6 （n=2 vs3） respectively. All scales of 5 cases of previously healthy patients were 0 -2. Conclusion Operation is vital for rescuing patient life and achieving excellent outcomes. Age is not a risk factor for intracranial aneurysms of elders. Early and aggressive operation is recommended for those without contraindications. Physical status is more important than age in decision- making.