高分级颅内动脉瘤破裂患者不同时机介入治疗的效果研究

Efficacy of interventional therapy at different times in patients with Hunt-Hess Ⅳ and Ⅴ high ruptured intracranial aneurysm

目的探讨高分级颅内动脉瘤破裂患者不同时机介入治疗的效果。方法选取2014年1月~2018年6月符合入选标准的Hunt-HessⅣ、Ⅴ级颅内动脉瘤破裂并接受介入栓塞术的患者115例,根据介入治疗时间分为早期治疗组(发病后<72h进行栓塞治疗)60例和延期治疗组(发病≥72h后进行栓塞治疗)55例,术后观察并发症发生情况,采用巴塞尔指数(BI)评分、生活质量指标调查表(DLQI)评分、格拉斯哥昏迷评分(GCS)和格拉斯哥预后评分(GOS)判断患者预后和疗效。结果早期治疗组并发症发生率低于延期治疗组(20.0%vs 36.4%,P <0.01);早期治疗组术后3个月BI评分明显高于延期治疗组[(25.4±1.7)分vs (6.5±1.9)分,P<0.05],早期治疗组治疗后DLQI评分总分明显低于延期治疗组[(8.5±0.5)分vs (13.6±1.3)分,P<0.05],术后GCS和出院时GOS高于延期治疗组[(6.5±1.5)分vs (5.8±1.4)分,(3.1±0.2)分vs (2.3±0.1)分,P<0.05]。结论在8h内对高分级颅内动脉瘤破裂患者进行介入治疗效果理想,值得在临床上进一步推广应用。

Objective To study the efficacy of interventional therapy at different times and the incidence of complications in patients with Hunt-Hess Ⅳ and Ⅴ ruptured intracranial aneurysm.Methods One hundred and fifteen patients with Hunt-HessⅣandⅤruptured intracranial aneurysm admitted to our hospital for interventional embolization were divided into early embolization group(n=60)and delayed embolization group(n=55).The postoperative incidence of complications in two groups was recorded.The outcome and therapeutic effect in patients with HuntHessⅣ and Ⅴ ruptured intracranial aneurysm were judged according to their BI score,DLQI score,GCS score and GOS.Results The incidence of complications was significantly lower while the BI score was significantly higher in early treatment group than in delayed treatment group after operation(20.0%vs 36.4%,P<0.01,25.4±1.7 vs 6.5±1.9,P<0.05).The BI score was significantly higher while the DLQI score was significantly lower in early treatment group than in delayed treatment group at 3 months after operation(25.4±1.7 vs 6.5±1.9,P<0.05;8.5±0.5 vs13.6±1.3,P<0.05).The postoperative GCS score and the GOS score at discharge were significantly higher in early treatment group than in delayed treatment group(P<0.05).Conclusion The efficacy of interventional therapy is good for Hunt-HessⅣ and Ⅴruptured intracranial aneurysm within 8 hafter its onset and can thus be further popularized in clinical practice.