高分级动脉瘤性蛛网膜下腔出血颅内夹闭术与介入治疗的近期预后对比研究

Prognosis of Patients With High-grade Aneurysmal Subarachnoid Hemorrhage Treated by Intracranial Surgery Using Clipping Method or Guglielmi Detachable Coils: A Comparative Study

目的：探讨颅内夹闭术与介入术在世界神经外科联盟（ WFNS）分级高分级动脉瘤性蛛网膜下腔出血（ aSAH）患者中的治疗效果。方法选取2011年1月—2014年10月在承德医学院附属医院神经科就诊的aSAH患者且符合WFNS分级Ⅳ~Ⅴ级者115例为研究对象，按照不同的手术方式分为治疗组60例和对照组55例。治疗组采用弹簧圈瘤腔内栓塞，对照组采用动脉瘤颈夹闭术。术后观察手术填塞程度，记录并发症发生情况。并随访3个月，记录格拉斯哥预后量表（GOS）评分。结果两组填塞程度比较，差异无统计学意义（U=1.55，P=0.46）。两组术中均未出现死亡病例。两组局灶性神经功能降低、脑积水、再出血发生率比较，差异均无统计学意义（ P〉0.05）；治疗组脑血管痉挛发生率低于对照组（ P〈0.05）。治疗组术后3个月预后优于对照组，差异有统计学意义（ U=8.19，P=0.04）。治疗组Ⅳ级患者术后3个月预后优于对照组，差异有统计学意义（ U=12.10，P=0.01）。两组Ⅴ级患者术后3个月预后比较，差异无统计学意义（ U=1.06，P=0.78）。结论两种术式对aSAH疗效确切、安全性较高。但弹簧圈瘤腔内栓塞治疗WFNS高分级aSAH患者近期预后生存质量较高。

Objective To investigate the therapeutic effect of surgeries using clipping method and guglielmi detachable coils（GDC）on patients with high -grade aneurysmal subarachnoid hemorrhage（aSAH）. Methods A total of 115 aSAH patients who received treatment in the Department of Neurosurgery,the Affiliated Hospital of Chengde medical University from January 2011 to October 2014 and who were of WFNS（ World Federation of Neurosurgical Societies） gradeⅣ-Ⅴwere enrolled and divided into treatment group（n=60）and control group（n=55）. The treatment group was given GDC,and the control group was administrated with clipping method. Embolism degree and complications were observed and recorded. Three -month follow-up was conducted to record Glasgow Outcome Scale （ GOS ） scores. Results The two groups were not significantly different in embolism degree（U=1. 55,P=0. 46）. No death occurred in both groups during surgeries. The two groups were not significantly different（P〉0. 05）in the deterioration of focal neural function,hydrocephalus and the incidence of rebleeding;the treatment group was lower（P〈0. 05）than control group in the incidence of cerebral angiospasm. The treatment group was superior to the control 3 months after surgery（U =8. 19,P =0. 04）. The treatment group was superior to the control in the grade-Ⅳ patients（U=12. 10,P=0. 01）,and there was no significant difference between the two groups in the grade-Ⅴpatients（U=1. 06,P=0. 78）. Conclusion The two surgical strategies on aSAH both have reliable curative effect and high safety,while high-grade aSAH patients who receive surgery using GDC has better quality of life in short-term outcomes.