动脉瘤性蛛网膜下腔出血的不同手术时机对预后的影响

Effect of surgical timing on outcome of patients with aneurysmal subarachnoid hemorrhage

目的探讨不同手术时机对动脉瘤性蛛网膜下腔出血患者预后的影响,总结实施早期手术的技巧。方法回顾性分析近3年来收治的327例自发性蛛网膜下腔出血(aSAH)患者的临床资料,根据治疗措施和手术时机进行分组,对各组的术中情况和术后结果进行比较。结果不同手术时机组的术中意外破裂率没有统计学差异,早期手术组和中期手术组治疗结果分级显著差于延期手术组。将非手术组患者分配到不同手术组后,早期手术组和中期手术组的治疗结果分级显著优于延期手术组。结论 aSAH后早期手术不仅能防止再出血降低死亡率,而且可通过清除蛛网膜下腔积血和去除骨瓣而改善预后,值得在临床推广。

Objective To investigate the effect of surgical timing on outcome of patients with aneurysmal subarachnoid hemorrhage. Methods The clinical data of 327 cases with aneurysmal subarachnoid hemorrhage treated in recent 3 years were analyzed retrospectively. All the cases were assigned to different groups according to the choice of treatment and surgical timing. The operative procedure and outcome of all cases in every group were recorded and analyzed statistically. Results There was no significant difference in the immature rupture rate of different surgical groups. The postoperative Glasgow Outcome Scales of early phase group and middle phase group were much lower than that of delayed phase group. After the cases of non-surgical group were assigned into the different surgical group, the Glasgow Outcome Scales of early phase group and middle phase group were superior to that of delayed phase group. Conclusion Early phase surgery is recommended because it can reduce the mortality by preventing the rebleeding and improve the prognosis by subarachnoid clot evacuating and bony flap removing.