动脉瘤夹闭术对不同Fisher分级患者蛛网膜下腔积血量及脑血管痉挛程度的影响

Aneurysm of the levels of Fisher in patients with subarachnoid hematocele and the influence degree of cerebral vasospasm

目的探讨动脉瘤夹闭术对不同Fisher分级患者蛛网膜下腔积血量及脑血管痉挛程度的影响。方法选取2014年1月至2015年1月就诊的蛛网膜下腔出血（SAH）患者60例，根据Fisher分级（其中Ⅰ级患者20例，Ⅱ级患者25例Ⅲ级患者15例）分为动脉瘤性SAH（A组，20例），非动脉瘤SAH（B组，18例），同期未出现破裂动脉瘤行夹闭术的患者为C组（22例），比较手术效果。结果以C组为标准，A、B、C组术前cT诊断结果差异无统计学意义（x2=0．12，P〉0．05）。治疗后，A、B两组脑痉挛评分均明显下降，其中Ⅰ级和Ⅱ级患者下降水平较III级患者明显，组间差异有统计学意义（x2=7．05，P〈0．05）；C组血流速度在第7天和第13天明显升高（X2=7．05，P〈0．05），而A、B组患者中Ⅰ、Ⅱ级患者的血流速度明显高于Ⅲ级患者血流速度（t=8．75，P〈0．05）。结论对于Fisher分级Ⅰ和Ⅱ级患者而言，行动脉瘤夹闭术增加患者蛛网膜下腔出血量，脑血管痉挛加重，对Ⅲ级患者起到的效果较明显。

Objective To investigate closure of different Fisher grade patients with subarachnoid product volume and the degree of cerebral vasospasm aneurysm clipping. Methods Patients with subarachnoid hemorrhage （SAH） were selected from January 2014 to January 2015 ,including 20 patients with grade Ⅰ,25 patients with grade Ⅱ,and 15 patients with grade Ⅲ. They were divided into 20 patients with aneurysmal SAH（A group） , 18 patients without aneurysmal SAH （ B group） and C group （22 cases）. The operation effect was compared. Results C group as the standard, CT preoperative diagnosis had no statistically significant difference among A, B, C group （ X2 = 0. 12, P 〉 0.05 ）. After treatment, the cerebral spasticity scores of A, B group were significantly decreased, and the level - Ⅰ and Ⅱ patients decreased more significantly compared with stage Ⅲ patients, the difference between the two groups was statistically significant（ X2 = 7.05,P 〈 0.05 ）. In group C, the blood flow velocity at the 7th and 13rd day significantly increased（ X2 = 7.05, P 〈 0.05 ） , and velocity of blood flow in group A and B Ⅰ and Ⅱ patients was significantly higher than that of grade m patients （ t = 8.75,P 〈 0.05 ）. Conclusion For the patients with Fisher grade Ⅰ and Ⅱ , the increase in the volume of subarachnoid hemorrhage, cerebral vasospasm, and the effect of the patients with Ⅲ were more obvious.