脑室外引流在重症破裂动脉瘤患者支架辅助栓塞治疗后的安全性分析

Safety of external ventricular drainage after stent-assisted embolization for poor-grade ruptured aneurysm

目的重症破裂动脉瘤患者的治疗是血管内介入栓塞治疗的重点和难点。文中通过探讨重症破裂动脉瘤患者急性期支架辅助栓塞后脑室外引流(EVD)的安全性,为重症破裂动脉瘤患者的临床治疗提供依据。方法回顾性分析南京总医院神经外科自2015年1月至2017年7月期间所有血管内治疗后行EVD的重症破裂动脉瘤患者临床资料,按照是否置入支架分为支架辅助组(n=14)和单纯栓塞组(n=13),比较2组术前一般资料及术后并发症。结果支架辅助组与单纯栓塞组间性别、年龄差异无统计学意义(P>0.05)。术前与出院前格拉斯哥昏迷评分(GCS)、脑室外引流距介入手术结束时间、术前合并脑室积血及脑积水以及EVD后合并穿刺道出血率、引流管留置时间、围手术期合并其他部位出血以及不良预后发生率在支架辅助组和单纯栓塞组患者间差异均无统计学意义(P>0.05)。结论重症破裂动脉瘤患者急性期支架辅助栓塞后行EVD治疗是一种相对安全的治疗策略。

Objective The management of poor-grade ruptured aneurysm is important and challenging in intravascular intervention.This study aimed to investigate the safety of external ventricular drainage（EVD） after stent-assisted embolization for patients with poor-grade ruptured aneurysm in the acute stage.Methods From January 2015 to July 2017,27 patients with poor-grade ruptured aneurysm underwent EVD after endovascular embolization by stent-assisted coiling（n = 14） or simple coiling（n = 13）.We compared the clinical data about and the postoperative complications between the two groups of patients.Results There were no statistically significant differences in the patients＇ age,gender,Glasgow Coma Scale（GCS） scores before embolization and discharge,the interval between EVD and the end of embolization,preoperative intraventricular hemorrhage and hydrocephalus,puncture-related bleeding after EVD,catheter-indwelling time,perioperative bleeding in other parts,or poor prognosis between the stent-assisted coiling and simple coiling groups（all P0.05）.Conclusion EVD after stentassisted embolization is a relatively safe strategy for the treatment of poor-grade ruptured aneurysm in the acute stage.