颅内动脉瘤破裂急性期与非急性期手术治疗效果研究

Study on the effect of intracranial aneurysm rupture acute and non-acute study of surgical treatment

目的：比较急性期及非急性期手术治疗颅内动脉瘤破裂的临床效果。方法共收集2012年5月-2014年7月来我院就诊的颅内动脉瘤破裂患者176例，将患者按照治疗的不同时间分为两组，急性期手术组91例，手术治疗时间为发病后0-3 d内，非急性期手术组85例，手术治疗时间为发病3 d后。两组患者均行动脉瘤夹闭术。比较两组术前再出血率、术中完全夹闭率、术后常见并发症情况、预后情况。结果（1）急性期手术组患者的术前再出血率（1.10%）与非急性期手术组（9.41%）比较明显较低，术中完全夹闭率（92.31%）与非急性期手术组（81.18%）比较明显较高，差异有统计学意义（P﹤0.05）。（2）急性期手术组术后脑梗死发生率（13.19%）、术后脑积水发生率（8.79%）较非急性期手术组（5.88%、4.71%）高，但差异不具有统计学意义（P﹥0.05）。（3）急性期手术组预后良好率（73.63%）与非急性期手术组（69.41%）比较较高，但差异不具有统计学意义（P﹥0.05）。结论急性期手术治疗颅内动脉瘤破裂患者可明显降低术前再出血率，提高术中完全夹闭率，明显降低患者由于再出血导致的死亡致残率，有利于疾病早期康复。

Objective To compare the clinical effect of intracranial aneurysms rupture with the acute and non-acute stage surgical. Methods All 176 cases with ruptured intracranial aneurysms were collected from May 2012 to July 2014 in our hospital, the patients were divided into two groups according to different treatment time, the acute surgery group included 91 cases, surgical treatment time of patients in this group was 0 to 3 days after the onset, the non-acute surgery group included 85 cases, the surgery time of this group was three days after onset. Two groups of patients were given underwent aneurysm surgery. Re-bleeding rates preoperative, intraoperative complete occlusion rate, postopera-tive complications, prognosis of two group were compared. Results （1）The intraoperative re-bleeding rate of the acute surgery group （1.10%） was significantly lower than the non-acute surgery group （9.41%）, the intraoperative complete occlusion rate （92.31%） was significantly higher than non-acute surgery group （81.18%）, there were significant differ-ence between two groups （P〈0.05）. （2）The incidence of infarction postoperative of the acute surgery group （13.19%）, the incidence of postoperative hydrocephalus （8.79%） were higher than non-acute surgery group （5.88%, 4.71%）, but there were no significant difference between two groups （P〉0.05）.（3）The good prognosis rate of acute surgery group （73.63%） was higher than the non-acute surgery group （69.41%）, but there were no significant difference between two groups （P〉0.05）. Conclusion Acute surgical treatment in patients with ruptured intracranial aneurysms can significantly reduce the rate of re-bleeding before surgery to improve intraoperative complete occlusion rate, patients＇ morbidity and mortality caused by bleeding are significantly reduced in favor of early rehabilitation of patients.