颅内动脉瘤性蛛网膜下腔出血不同时机开颅手术及血管内治疗的疗效及预后因素分析

The curative effect of different operation time of craniotomy and endovascular treatment on intracranial aneurysmal subarachnoid hemorrhage and prognosis

目的探讨血管内介入治疗和开颅手术时机与颅内动脉瘤破裂的疗效及预后的关系。方法回顾分析2010-01—2013-01本院收治的162例颅内动脉瘤破裂导致蛛网膜下腔出血患者的资料,按照Hunt-Hess分级法,低级别患者98例,高级别患者64例,分析两种手术时机(早期和延期手术)与手术方式(血管内介入治疗和开颅手术)对各级别患者疗效的影响。结果低级别组手术时机比较,两种手术方式早期治疗的疗效均显著优于延期,差异有统计学意义(χ2=5.85、5.69,P<0.05);高级别组延期治疗的疗效显著优于早期,差异有统计学意义(χ2=6.84、7.13,P<0.01)。血管内介入治疗和开颅手术对两级别患者的疗效影响不明显,差异无统计学意义(P>0.05)。结论颅内动脉瘤的治疗与手术时机有关,但与手术方式无相关性。积极的血管内介入治疗和开颅手术对颅内动脉瘤破裂导致蛛网膜下腔出血的患者有较好的治疗作用,并能明显改善患者预后。

Objective To discuss the curative effect of different operation time craniotomy and endovascuIar treatment on intracranial aneurysmal subarachnoid hemorrhage and prognosis. Methods 162 cases with intracranial aneurysmal subarach- noid hemorrhage from January 2010 to January 2013 in our hospital were retrospectively analyzed according to Hunt--Hess classification method, the low level with 98 cases, high level with 64 cases, and the curative effect of two kinds of operation time （early and delayed surgery） and operation （endovascular treatment and craniotomy） were analysed. Results To compare the operation time of low level group, the curative effect of early surgery were significantly superior to delay surgery （Z2~ 5.85 and 5.69, P〈.0.05 ）;To compare the operation time o{ high levd group, the curative effect of delayed surgery were signi{i cantly superior to early surgery （%z -- 6.84 and 7. 13）. The difference of curative effect between endovascular treatment and craniotomy was not significant. Conclusion Treatment for intracranial aneurysms is associated with operation time,but has no correlation with surgical procedure . Positive endovascular treatment and craniotomy in patients with intracranial aneurysmal subarachnoid hemorrhage have good treatment effect, and can obviously improve the prognosis.