动脉瘤性蛛网膜下腔出血患者开颅夹闭术与介入栓塞术后认知功能的对比研究

A comparative study on cognitive function in patients with aneurysmal subarachnoid hemorrhage between surgical clipping and interventional embolization

目的探讨开颅夹闭术与介入栓塞术对动脉瘤性蛛网膜下腔出血(SAH)患者认知功能的影响。方法分析2015年7月—2017年12月,行开颅夹闭术或介入栓塞术治疗的122例动脉瘤性蛛网膜下腔出血患者的临床资料。采用简易精神状态检查(MMSE)量表对所有患者的认知功能进行评定;每例患者共进行4次MMSE评分:入院时(治疗前)、术后近期(术后2周)、中期(术后2个月)、远期(术后1年)。将患者按照手术治疗方式分为开颅夹闭组(42例)和介入栓塞组(80例),分别对比两组患者术前、近期、中期和远期的MMSE评分;并对不同时期认知功能障碍发生率进行比较。结果两组患者术前MMSE评分的差异无统计学意义(P>0.05);介入栓塞组在术后早期、中期及远期的MMSE评分均明显高于开颅夹闭组(均P<0.05)。开颅夹闭组患者在术后近期及中期的认知功能障碍发生率均明显高于介入栓塞组(均P<0.05);但在术后远期,两组患者认知功能障碍发生率的差异无统计学意义(P>0.05)。结论行开颅夹闭术的动脉瘤性蛛网膜下腔出血患者,术后近期及中期的认知功能障碍发生率明显高于介入栓塞术患者。介入栓塞治疗动脉瘤有助于减轻认知功能的损害。

Objective To investigate the effect of craniotomy and interventional embolization on cognitive function in patients with aneurysm subarachnoid hemorrhage(SAH).Methods The clinical data of 122 patients with aneurysm SAH from July 2015 to December 2017 were analyzed.The cognitive function of all patients was evaluated with the mini-mental state scale(MMSE).Each patient was graded for 4 times:admission(before treatment),early term(2 weeks after operation),middle term(2 months after operation),and long term(1 year after operation).All the patients were divided into craniotomy clipping group(42 cases)and interventional embolization group(80 cases)according to the treatment method.The changes of MMSE scores were compared before,early,middle and long term,and the incidence of cognitive dysfunction in different periods was observed.Results There was no difference in preoperative MMSE score between the two groups,but in the early,the middle and long period,the MMSE score in the interventional embolization group was significantly higher than that in the craniotomy clipping group,and in the early and middle postoperative period,the incidence of cognitive dysfunction in the craniotomy clipping group was significantly higher than that in the interventional embolization group,there was no significant difference between the two groups at one year after operation.Conclusions The incidence of cognitive dysfunction in the craniotomy clipping group is much higher than that in the interventional embolization group in the early and middle term of operation.Interventional embolization is helpful to alleviate the cognitive impairment of aneurysms.