高分级动脉瘤性蛛网膜下腔出血治疗策略及预后分析

Management strategy and prognosis analysis for poor- grade aneurysmal subarachnoid hemorrhage

目的：探讨高分级动脉瘤性蛛网膜下腔出血的显微手术疗效及预后影响因素。方法回顾性分析43例高分级动脉瘤患者的临床资料，其中 Hunt-Hess IV 级30例，V 级13例，24例行急诊手术（发病后6 h 之内），16例行超早期手术（发病后24 h 之内）。采用格拉斯哥转归评分评价患者的预后。结果行显微手术治疗的43例患者中，GOS 4～5分者19例，预后优良率44．2％，GOS 1～2分者16例，极差率37．2％， Hunt-Hess IV 级患者总体预后优于 V 级患者（Z ＝－2．486，P ＝0．016）。合并脑内血肿者18例，早期手术干预有效者（GOS 3～5分）12例，与剩余组患者预后差异无统计学意义（χ2＝0．103，P ＝1．000）。结论超早期手术或急诊手术可尽早缓解恶性颅高压，降低颅内破裂动脉瘤再出血风险，减少高分级动脉瘤患者病死率。

Objective To investigate the efficacy of microsurgery and predictors of outcome for poor -grade aneurysmal subarachnoid hemorrhage（aSAH）.Methods Clinical data of 43 patients of poor -grade aSAH who per-formed microsurgery were retrospectively analyzed.There were 30 patients with Hunt -Hess grade IV and 1 3 patients with grade V.24 patients received emergency operation（within 6hours after onset）,1 6 patients received ultra -early operation（within first 24hours after onset）.Outcome was assessed by Glascow Outcome Scale（GOS）.Results Of 43 patients who received microsurgery,favorable outcome was achieved by 1 9 cases of 43 cases （44.2%）,poor outcome was achieved by 1 6 cases of 43 cases （37.2%）,the overall outcome of patients with Hunt -Hess grade IV was better than that with grade V（Z =-2.486,P =0.01 6）.1 8 patients with intracerebral hematoma received ultra -early or emergency operation,effective surgical intervention（GOS≥3）achieved in 1 2 patients,there was no signifi-cant difference in prognosis between the patients and the others who without intracerebral hematomas（χ2 =0.1 03,P =1 .000）.Conclusion The ultra -early or emergency surgery could avoid the risk of aneurysmal re -rupture,relieve malignant intracranial hypertension as soon as possible and decrease the mortality of poor -grade aSAH patients.