动脉瘤性蛛网膜下腔出血早期血管内治疗

Comparison of the efficacy of embolization at early stage with at delayed stage for aneurysmal subarachnoid hemorrhage

目的探讨动脉瘤性蛛网膜下腔出血(aSAH)的早期血管内治疗的效果。方法回顾性分析2009年9月至2011年3月收治的62例aSAH患者的临床资料,其中出血后3d内行血管内治疗32例(早期组),出血后4～14d行血管内治疗30例(延期组)。结果早期组栓塞术后即刻造影示100%、95%、80%和<80%栓塞者分别为14、14、、3和1例,延期组分别为15、2、12、2和1例,两组动脉瘤栓塞率无统计学差异(P>0.05)。早期组并发症发生率(40.6%,13/32)明显低于延期组(90.0%,27/30;P<0.05)。早期组出血后3、7和14d大脑中动脉流速均明显低于延期组(P<0.05)。出院后随访6个月,按GOS评分评估患者预后;早期组恢复良好24例,轻残5例,重残3例;延期恢复良好14例,轻残8例,重残6例,死亡2例;早期组预后良好率(75.0%,24/32)明显高于延期组(46.7%,14/30;P<0.05)。结论 aSAH患者早期栓塞治疗可减少相关并发症,改善患者预后。

Objective To compare the efficacy of embolization at early stage with at delayed stage for aneurysmal subarachnoid hemorrhage （aSAH）. Methods The clinical data of 62 patients with aSAH, of whom, 32 underwent embolization at early stage （within 3 days） of the SAH （early group） and 30 underwent embolization at delayed stage （4 to 14 days） of the SAH （delayed group） from September, 2009 to March, 2011, were analyzed retrospectively. Results The DSA immediately after embolization showed that 100%, 95%, 80% and 〈80% occlusion of the ruptured aneurysms were achieved in 14, 14, 3 and 1 patients in early group, and 15, 12, 2 and 1 patients in delayed group, respectively. There were no significant differences in the occlusion rate between early group and delayed group （P〉0.05）. The rate of complications in early group （40.6%, 13/32） was significantly lower than that （90.0%, 27/30） in delayed group （P〈0.05）. The findings of transcranial Doppler ultrasonography showed that the velocities of middle cerebral artery were significantly faster in early group （60.20＋8.63 cm/s, 92.30_＋ 12.19 cm/s and 105.60_＋ 13.57 cm/s, respectively） than those （75.50_＋6.95 cm/ s, 121.50_＋7.39 cm/s and 136.20_＋10.36 cm/s, respectively） in delayed group 3, 7 and 14 days after the SAH （P〈0.05）. All patients were followed up for 6 months after hospital discharge, and the outcomes showed that 24 patients recovered well, 5 were mediately disabled and 3 severely disabled in early group, and 14 recovered well, 8 were mediately disabled and 6 severely disabled and 2 died in delayed group. The well recovery rate was significantly higher in early group （75.0%, 24/32） than that （43.8%, 14/32） in delayed group （P〈0.05）. Conclusion Embolization at early stage of aSAH is superior to emboliation at delayed stage of aSAH.