摘要
目的分析颅内囊状动脉瘤Hunt-HessⅣ~Ⅴ分级患者超早期行血管内栓塞术联合持续性腰大池引流术的预后。方法回顾性分析大连大学附属中山医院神经外一科自2014年1月至2017年12月收治的颅内囊状动脉瘤Hunt-HessⅣ~Ⅴ分级患者32例(Ⅳ级24例,Ⅴ级8例)的临床资料,其中16例超早期行血管内栓塞术联合持续性腰大池引流术(A组),另外16例患者入院超早期行血管内栓塞术(B组);根据术后CT、TCD及临床症状,判断是否发生脑血管痉挛、脑积水及脑梗死,记录2组患者住院时间,对2组患者治疗后第1、3、6月的预后进行评价。结果 A组发生脑血管痉挛5例、脑积水9例、脑梗死6例,住院时间(25±8)d;B组发生脑血管痉挛8例、脑积水11例、脑梗死9例,住院时间(28±9)d;2组比较差异有统计学意义(P<0.05)。2组治疗后1个月GCS评分比较,差异无统计学意义(P>0.05);治疗后3、6个月改良Rankin量表评分比较,差异均有统计学意义(P<0.05)。结论颅内囊状动脉瘤Hunt-HessⅣ~Ⅴ分级患者术后持续腰大池引流可减少脑血管痉挛、脑积水及脑梗死等并发症的发生,减少住院时间,提高患者术后3个月及半年恢复水平。
Objective To observe the prognosis of patients with Hunt-Hess gradeⅣ-Ⅴof intracranial saccular aneurysms who were treated with ultra-early emergency embolization and continuous lumbar drainage.Methods The clinical date of 32 patients with Hunt-Hess gradeⅣ-Ⅴintracranial saccular aneurysm(gradeⅣ,n=24 and gradeⅤ,n=8)admitted from January 2014 to December 2017 were analyzed retrospectively.Sixteen cases of them were treated with ultra-early emergency embolization and continuous lumbar drainage(group A)and 16 underwent emergency embolization(group B).The neurological prognosis of the patients was evaluated at 1,3 and 6 months after treatment.According to head CT,TCD and clinical manifestation of postoperative patients,we determined whether there were cerebrovascular spasm,hydrocephalus and cerebral infarction,and counted the hospitalization time of the two groups.Results Group A has 5 patients with cerebral vasospasm,9 patients with hydrocephalus,6 patients with cerebral infarction and patients were in hospital for(25±8)d.Group B has 8 patients with cerebral vasospasm,11 patients with hydrocephalus,9 patients with cerebral infarction and patients were in hospital for(28±9)d.There was no significant difference in GCS between the group A and group B at 1 month after treatment(P>0.05);but there was significant difference in Rankin prognostic scores at 3 and 6 months after treatment between the 2 groups(P<0.05).Conclusion Ultra-early emergency embolization and continuous lumbar drainage can reduce the number of patients of cerebral vasospasm,hydrocephalus and cerebral infarction,and reduce the time of hospitalization,and improve the recovery level of 3 months and half a year after treatment.
作者
周根
邓东风
董斌
张绪新
李彦钊
Zhou Gen;Deng Dongfeng;Dong Bin;Zhang Xuxin;Li Yanzhao(Fist Department of Neurosurgery,Affiliated Zhongshan Hospital of Dalian University,Dalian 116001,China;Department of Neurosurgery,The First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)
出处
《中华神经创伤外科电子杂志》
2018年第5期264-267,共4页
Chinese Journal Of Neurotraumatic Surgery:Electronic Edition
关键词
高级别蛛网膜下腔出血
颅内动脉瘤
持续性腰大池引流术
介入
High grade subarachnoid hemorrhage
Intracranial aneurysms
Continuous lumbar drainage
Interventional therapy