血管内介入与显微外科夹闭治疗动脉瘤性蛛网膜下腔出血的效果及预后影响因素分析

Effect and prognosis of endovascular intervention and microsurgical clipping in the treatment of aneurysmal subarachnoid hemorrhage

目的:研究血管内介入与显微外科夹闭治疗动脉瘤性蛛网膜下腔出血(aSAH)的效果,并分析预后影响因素。方法:抽取2017年1月至2020年1月于河南科技大学第一附属医院接受治疗的aSAH患者68例,根据不同治疗方法将其分为介入组和夹闭组,每组34例。介入组接受弹簧圈栓塞术治疗,夹闭组接受动脉瘤夹闭术治疗,比较术后3个月治疗效果及治疗过程出现的并发症情况,分析预后影响因素。结果:两组治疗后3个月恢复情况比较差异有统计学意义(P<0.05);介入组术后脑血管痉挛发生率低于夹闭组,差异有统计学意义(P<0.05);两组术后脑积水、再出血、局灶性神经功能降低发生率比较差异未见统计学意义(P>0.05);Hunt-HESS分级、早期降颅压治疗不同分组间预后情况比较差异有统计学意义(P<0.05),不同年龄、性别、动脉瘤位置及手术时机预后比较差异未见统计学意义(P>0.05);Hunt-HESS分级和是否接受早期颅内降压治疗是影响aSAH预后的危险因素(P<0.05)。结论:血管内介入治疗aSAH近期治疗效果较好,能促进预后,降低脑血管痉挛发生率;Hunt-HESS分级和早期颅内降压治疗是影响aSAH预后的危险因素。

Objective To investigate the clinical effect and prognostic factors of endovascular intervention and microsurgical clipping in the treatment of aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 68 patients with aSAH in the First Affiliated Hospital of Henan University of Science and Technology from January 2017 to January 2020 were enrolled,and they were divided into two groups according to different treatment methods,each with 34 cases.Intervention group received guglielmi detachable coils,and clipping group received microsurgical clipping.Then the clinical efficacy,complication rate and prognostic factors were analyzed.Results There was significant difference in the recovery of the two groups 3 months after treatment(P<0.05).The incidence of postoperative cerebral vasospasm in the intervention group was significantly lower than that in the clipping group(P<0.05),while no significant difference was found in the incidence rate of postoperative hydrocephalus,rehemorrhage,and focal nervous functional defects(P>0.05).The prognosis of patients with different Hunt-HESS grades and early intracranial pressure reduction treatments was significantly different(P<0.05),while the prognosis among patients with different age,gender,aneurysm location and operation timing had no significant difference(P>0.05).Hunt-HESS classification and early intracranial hypotensive therapy were risk factors that affect the prognosis of aSAH(P<0.05).Conclusions The short-term efficacy of intravascular interventional therapy for aSAH is good,which can promote the prognosis and reduce the incidence of cerebral vasospasm,moreover,Hunt-hess grade and early intracranial antihypertensive therapy are risk factors for the prognosis of aSAH.