不同治疗方式下高龄动脉瘤性蛛网膜下腔出血病人临床特点分析

Clinical characteristics of aneurysmal subarachnoid hemorrhage in elderly patients under different treatment methods

目的分析不同治疗方式下高龄动脉瘤性蛛网膜下腔出血(aSAH)的临床特点。方法2018年9月~2020年11月我科收治的aSAH病人336例,根据年龄分为两组,高龄组48例,年龄≥70岁;非高龄组288例,年龄<70岁。比较两组不同治疗方式的性别组成、入院情况、动脉瘤特征、预后等指标。结果两组性别、动脉瘤颈宽及纵横比、动脉瘤破裂及再出血等比较,差异无统计学意义(P>0.05)。动脉瘤位置(主要是颈内动脉及后交通动脉瘤)、高血压史、Hunt-Hess分级、Fisher分级、预后、术后缺血灶形成、脑积水等比较,差异有统计学意义(P<0.05)。结论影响高龄病人aSAH的预后因素很多,对高龄病人需全面分析病情制定手术方案。经过评估可优先选择血管内栓塞治疗。手术夹闭病人需尽早手术清除血肿,减少缺血性病灶发生。术后密切监测病人的症状与体征,早期发现与治疗并发症,可提高高龄aSAH病人的手术治疗效果。

Objective To investigate the clinical characteristics of aneurysmal subarachnoid hemorrhage(aSAH)in elderly patients under different treatments.Methods A total of 48 cases of aged aSAH patients over 70 years old treated in Department Ⅲ of Neurology,Renmin Hospital of Wuhan University from September 2018 to November 2020 were collected as the elderly group,and 288 cases of aSAH patients under 70 years old admitted during the same period were collected as the non-elderly group for retrospective analysis.The gender composition,admission condition,aneurysm characteristics,prognosis of the two groups were compared under different treatment options.Results There were no significant differences in the aspect of gender composition,aneurysm neck widths,aspect ratios,aneurysm rupture and rebleeding between the two groups(P>0.05).There were statistically significant differences in the aspect of aneurysm locations(mainly internal carotid artery and posterior communicating aneurysms),histories of hypertension,Hunt-Hess grades,Fisher grades,prognosis,cerebral infarctions and hydrocephalus(P<0.05).Conclusion There are many prognostic factors affecting aSAH in elderly patients,and it is necessary to make a comprehensive analysis of the condition and the surgical plan for elderly patients.After evaluation,endovascular embolization is preferred.For patients with surgical clipping,hematoma should be removed as soon as possible to reduce the occurrence of infarction,which can improve the surgical treatment effect of elderly patients with aSAH.