介入性栓塞术对颅内动脉瘤SAH者并发脑血管痉挛的影响

Effect of interventional embolization on cerebral vasospasm in patients with intracranial aneurysm SAH

目的对比分析开颅夹闭术与介入性栓塞术对颅内脑动脉瘤蛛网膜下腔出血(SAH)患者的脑血管痉挛事件发生率的影响。方法 2014年1月至2016年12月在安徽省池州市人民医院神经外科监护室接受治疗的137例颅内动脉瘤致SAH患者的临床资料。根据治疗手段的不同将入选者分成观察组(栓塞术,105例)和对照组(夹闭术,32例)两组。比较两组患者的基线资料及脑血管痉挛相关因素情况。结果两组患者的基线资料无明显统计学差异(P>0.05)。观察组患者的监护时间、住院时间、症状性痉挛发生率均明显低于对照组,动脉瘤明显大于对照组,且血管痉挛程度、动脉瘤部位也与对照组存在明显差异(P<0.05)。两组患者治疗前NIHSS评分对比无显著差异(P>0.05),术后2周两组NIHSS评分均降低,但观察组患者降低程度显著低于对照组,差异具有统计学意义(P<0.05)。观察组不良事件发生率(1.9%)低于对照组(6.3%)(χ~2=1.634,P=0.20)。结论介入性栓塞术治疗颅内动脉瘤SAH患者的临床疗效突出,可大大减少此类患者发生脑血管痉挛事件的风险,值得推广。

Objective Toanalyze the influence of efficacy of traditional combination therapy and intelligent multi-dimensional training for craniotomy and interventional embolization on the occurrence rate of cerebral vasospasm of the intracranial aneurysm patients with subarachnoid hemorrhage（SAH）.Methods Clinical data of 137 intracranial aneurysm SAH patients received treatment at department of neurosurgery guardianship at the people＇s hospitalof Chizhou,Anhui province from January,2014 to December,2016 was retrospectivelyanalyzed.Patients included were divided into two groups according to the treatment,observe group（craniotomy,105 cases）and control group（interventional embolization,32 cases）.The general information,the related indexes of cerebral vasospasm in two groups were compared.Results The general information in two groups had no statistical difference（P〉0.05）.The monitoring time,time of hospitalization,and incidence of symptomatic spasm in observe group were obviously lower than those in control group（P〈0.05）.The aneurysm volume in observe group was obviously bigger than that in control group,and the degree of vasospasm,aneurysm site in two groups had statistical difference（P〈0.05）.There was no significant difference in NIHSS scores before treatment between the two groups（P〉0.05）.Both NIHSS scores decreased after 2 weeks,but the decrease in the observation group was significantly lower than that in the control group（P〈0.05）.The adverse event rate in observe group（1.9%）was lower than that（6.3%）in control group（χ^2=1.634,P=0.20）.Conclusion The clinical efficacy of interventional embolization of the intracranial aneurysm patients with SAH is significant,which could the risk of cerebral vasospasm in SAH patients.It＇s worth promoting.