超早期显微夹闭手术治疗高分级动脉瘤性蛛网膜下腔出血患者的预后效果分析

Prognostic Effect of Ultra-early Microscopic Clip Operation in Treating Patients With High-Grade Aneurysmal Subarachnoid Hemorrhage

目的分析超早期显微夹闭手术治疗高分级动脉瘤性蛛网膜下腔出血（aSAH）患者的预后效果。方法选取延安大学附属医院2009年1月—2015年2月收治的高分级（Hunt-Hess分级4-5级）aSAH患者100例,按照手术时机分为超早期组46例、早期组32例与中晚期组22例。患者均接受显微夹闭手术治疗,超早期组患者于发病后1 d内手术,早期组患者于发病后1-3 d手术,中晚期组患者则于发病3 d后手术。术后随访6个月,比较3组患者预后效果、并发症发生情况及不同Hunt-Hess分级患者预后效果。结果超早期组患者预后效果优于早期组和中晚期组（u值分别为2.350、3.348,P〈0.05）。Hunt-Hess分级为4级患者中,超早期组患者预后效果优于早期组与中晚期组（u值分别为2.904、2.362,P〈0.05）;Hunt-Hess分级为5级患者中,超早期组患者预后效果优于中晚期组（u=2.389,P〈0.05）。3组患者再出血发生率、脑血管痉挛发生率、术后脑梗死发生率比较,差异无统计学意义（P〉0.05）。结论超早期显微夹闭手术治疗高分级aSAH患者的预后效果良好,尤其是Hunt-Hess分级为4级的aSAH患者。

Objective To analyze the prognostic effect of ultra- early microscopic clip operation in treating patients with high- grade aneurysmal subarachnoid hemorrhage. Methods A total of 100 patients with high- grade（ with 4-,5-grade of Hunt-Hess grading） aneurysmal subarachnoid hemorrhage were selected in the Affiliated Hospital of Yan＇ an University from January 2009 to February 2015,and they were divided into A group（ received microscopic clip operation within 1 day after onset,n = 46）, B group（ received microscopic clip operation within 1 day to 3 days after onset, n = 32） and C group（ received microscopic clip operation after 3 days of onset,n = 22） according to operation opportunity. All of the patients were followed up for 6 months,prognostic effect and incidence of complications were compared among the three groups. Results The prognostic effect of A group was statistically significantly better than that of B group（ u = 2. 350） and C group（ u = 3. 348）,respectively（ P〈0. 05）. In patients with 4- grade of Hunt-Hess grading, the prognostic effect of A group was statistically significantly better than that of B group（ u = 2. 904） and C group（ u = 2. 362）,respectively（ P〈0. 05）; while in patients with 5- grade of Hunt-Hess grading,the prognostic effect of A group was statistically significantly better than that of C group（ u= 2. 389,P〉0. 05）. No statistically significant differences of incidence of rehaemorrhagia,cerebral vasospasm or postoperative cerebral infarction was found among the three groups（ P〈0. 05）. Conclusion Ultra- early microscopic clip operation has good prognostic effect in treating patients with high- grade aneurysmal subarachnoid hemorrhage,especially in treating patients with 4- grade of Hunt-Hess grading.