Hunt-Hess Ⅳ~Ⅴ级颅内动脉瘤并颅内血肿早期手术治疗

Early surgical treatment of Hunt-Hess Ⅳ ~ Ⅴ grade intracranial aneurysms and intracranial hematoma

目的探讨Hunt-HessⅣ~Ⅴ级颅内动脉瘤并颅内血肿早期手术治疗的效果。方法回顾分析我院2008年3月至2013年3月采用急诊手术治疗的Hunt-HessⅣ~Ⅴ级颅内动脉瘤并颅内血肿患者完整病例资料,共计56例。Hunt-HessⅣ型30例,Hunt-HessⅤ型26例,术后均随访3~24个月。采用统计学的方法对患者的预后良好率、术后并发症以及病死率进行分析。结果56例患者中,20例为前交通动脉瘤,18例为大脑中动脉瘤,12例为后交通动脉瘤,3例为颈段动脉瘤,2个为大脑前动脉瘤,1例为颈内动脉分叉部位动脉瘤。术后GOS评分18例患者死亡(GOS I级);13例患者处于植物人状态(GOS II级);8例患者重度残废,生活不能自理(GOS III级);8例患者中度残废,生活可以自理(GOS IV级);9例患者恢复良好,不影响工作和学习恢复(GOS V级)。总优良率为30.40%,患者术后病死率为32.12%。结论 Hunt-HessⅣ~Ⅴ级颅内动脉瘤并颅内血肿早期手术能降低患者术后并发症和病死率。

Objective To investigate early surgical treatment results of Hunt-Hess Ⅳ ~Ⅴ grade intracranial aneurysms and in-tracranial hematoma.Methods The complete clinical data of 56 cases Hunt-Hess Ⅳ~Ⅴ grade intracranial aneurysms and intracranial he-matoma who adopted emergency surgery in our hospital from March 2008 to March 201 3 were retrospectively analysed.There were 30 cases of Hunt-Hess Ⅳ type and 26 cases of Hunt-Hess Ⅴtype.The patients were followed up for 3 to 24 months.The prognosis good rate,postopera-tive complications,and mortality were analyzed using a statistical approach.Results Among the 56 cases of Hunt-Hess Ⅳ and Ⅴ grade in-tracranial aneurysms and intracranial hematoma,there were 20 cases of anterior communicating artery aneurysm,1 8 of cerebral aneurysm,1 2 of posterior communicating artery aneurysm,3 of cervical aneurysms,and 2 of anterior cerebral artery aneurysm.GOS score after the surgery was:3 patients died (GOS I grade),5 patients were in a vegetative state (GOS II level),4 patients had severe disability,and could not take care of themselves (GOS III level),4 patients had moderate disability,and could take care of themselves (GOS IV grade),and 40 patients recov-ered well without affecting the work and study (GOS V level).The overall good rate was 30.40%.The mortality rate was 32.1 2%.Conclu-sion Early surgery of Hunt-Hess Ⅳ~Ⅴ grade intracranial aneurysms and intracranial hematoma for patients can reduce the postoperative complications and mortality.