血管介入栓塞治疗时机对颅内动脉瘤患者并发症及神经功能的影响

Effect of the operation time of vascular interventional embolization on complication risk and neurologic function in patients with intracranial aneurysm

目的探讨血管介入栓塞治疗时机对颅内动脉瘤患者并发症及神经功能的影响。方法回顾性选择2014年1月至2016年1月华中科技大学同济医学院附属协和医院神经外科住院部颅内动脉瘤患者400例,根据手术时间的不同将患者分为观察组与对照组,各200例。观察组患者采用早期血管介入栓塞术,即手术时间距临床症状出现时间≤3d;对照组患者采用延期血管介入栓塞术,即手术时间距临床症状出现时间>3 d。比较2组患者临床疗效、并发症发生情况、神经功能[美国国立卫生研究院卒中量表(NIHSS)评分]和日常生活活动能力[改良Barthel指数(MBI)评分]。结果观察组患者完全栓塞比例明显高于对照组[81.0%(162/200)比56.0%(112/200)],大部分栓塞与部分栓塞比例明显低于对照组[16.0%(32/200)比24.0%(48/200)、3.0%(6/200)比20.0%(40/200)],差异有统计学意义(P<0.05)。观察组并发症发生率明显低于对照组[0.5%(1/200)比4.5%(9/200)],差异有统计学意义(P<0.05)。治疗前,2组患者NIHSS评分、MBI评分比较,差异均无统计学意义(均P>0.05);治疗后,观察组与对照组患者NIHSS评分均明显低于治疗前[(3.8±1.9)分比(19.6±5.2)分、(9.0±2.0)分比(19.7±5.2)分],MBI评分均明显高于治疗前[(90±10)分比(51±10)分、(75±10)分比(51±10)分],且观察组患者NIHSS评分明显低于对照组,MBI评分明显高于对照组,差异均有统计学意义(均P<0.05)。结论早期血管介入栓塞术治疗颅内动脉瘤的临床疗效优于延期血管介入栓塞术,且有助于降低并发症发生风险,改善神经功能与日常生活活动能力。

Objective To explore the effect of operation time of vascular interventional embolization on complication risk and neurologic function in patients with intracranial aneurysm. Methods Four hundred patients with intracranial aneurysm who had surgical treatments in Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2014 to January 2016 were retrospectively analyzed. Two hundred patients were treated by early vascular interventional embolization within 3 d after symptom attack（observation group）; 200 patients had interventional embolization 3 d after symptom attack（control group）. Clinical curative effect, complications, neurologic function［the National Institutes of Health Stroke Scale（NIHSS）］ and activities of daily living［the Modified Barthel index（MBI）］ were analyzed. Results Complete embolism rate in observation group was significantly higher, most embolism rate and partial embolism rate were significantly lower than those in control group［81.0%（162/200） vs 56.0%（112/200）, 16.0%（32/200） vs 24.0%（48/200）, 3.0%（6/200） vs 20.0%（40/200）］（P＜0.05）. Postoperative complication rate in observation group was significantly lower than that in control group［0.5%（1/200） vs 4.5%（9/200）］（P＜0.05）. The NIHSS score and MBI score had no significant differences between groups before operation（P＞0.05）. After operation, the NIHSS score was significantly lower and the MBI score was significantly higher than those before operation in observation group and control group［NIHSS： （3.8±1.9）scores vs （19.6±5.2）scores, （9.0±2.0）scores vs （19.7±5.2）scores; MBI： （90±10）scores vs （51±10）scores, （75±10）scores vs （51±10）scores］, and there were significant differences between groups（P＜0.05）. Conclusion Early vascular interventional embolization treating intracranial aneurysm can reduce operation related complications, improve neurologic function and daily living activities.