Hunt-Hess Ⅳ、Ⅴ级颅内动脉瘤破裂患者不同时机应用介入栓塞术治疗的临床效果观察

Observation of clinical effects of interventional embolization at different timings on patients with Hunt-Hess gradeⅣandⅤruptured intracranial aneurysms

目的探讨Hunt-HessⅣ、Ⅴ级颅内动脉瘤破裂患者不同时机应用介入栓塞术治疗的临床效果。方法选择本院2016年12月至2019年12月接受介入栓塞术治疗的98例Hunt-HessⅣ、Ⅴ级颅内动脉瘤破裂患者,根据介入治疗时机进行分组,晚期组48例为入院72h后进行治疗,早期组50例为入院72h内给予治疗。采用格拉斯哥评分(GCS)、格拉斯哥预后评分(GOS)及巴塞尔指数(BI)评估两组患者预后效果,利用数字减影血管造影(DSA)评估两组动脉栓塞成功率,并记录其随访3个月内的相关并发症发生情况。结果早期组患者术后3d、14d GCS量表评分、出院时GOS量表评分及出院后3个月BI量表评分均低于晚期组(P均<0.05);早期组动脉栓塞成功率高于晚期组(P<0.05);随访3个月,早期组患者相关并发症总发生率低于晚期组(P<0.05)。结论入院72h内进行介入栓塞术治疗Hunt-HessⅣ、Ⅴ级颅内动脉瘤破裂可明显提高临床栓塞成功率,改善预后,降低术后并发症发生。

Objective To explore the clinical effects of interventional embolization at different timings on patients with Hunt-Hess grade Ⅳ and Ⅴruptured intracranial aneurysms. Methods A total of 98 patients with Hunt-Hess grade Ⅳ and Ⅴruptured intracranial aneurysms who underwent interventional embolization from December 2016 to December 2019 in our hospital were analyzed, and the patients were grouped according to the timings of interventional treatment. Among them, 48 patients in advanced group were treated at 72 h after admission, and 50 patients in early group were treated within 72 h after admission. Glasgow coma score(GCS), Glasgow outcome score(GOS) and Basel index(BI) were used to evaluate the prognosis effects in the two groups. Digital subtraction angiography(DSA) was used to evaluate the success rate of arterial embolization in the two groups, and the occurrence of related complications were recorded within 3 months of follow-up. Results The GCS score at 3 d and 14 d after surgery, GOS score at discharge and BI score at 3 months after discharge in early group were significantly lower than those in advanced group(all P<0.05). The success rate of arterial embolization in early group was significantly higher than that in advanced group(P<0.05). Within 3 months of follow-up, the total incidence rate of related complications in early group was significantly lower than that in advanced group(P<0.05). Conclusion Interventional embolization for Hunt-Hess grade Ⅳ and Ⅴ rupture intracranial aneurysms within 72 h after admission can significantly improve the success rate of clinical embolization, promote the prognosis, and significantly reduce the occurrence of postoperative complications.