介入栓塞与开颅夹闭治疗前循环高分级aSAH的临床研究

Clinical study of endovascular coiling and surgical clipping for anterior circulation high-grade aSAH

目的探讨介入栓塞和开颅夹闭治疗前循环高分级动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)预后的差异。方法回顾性分析62例前循环高分级aSAH病人的临床资料,采用介入栓塞治疗(栓塞组)36例,开颅夹闭治疗(夹闭组)26例。住院期间评估病人肺炎、脑血管痉挛状况,术后3个月后应用改良Rankin量表(modified Rankinscale,mRS)评估病人预后。结果术后发生脑血管痉挛9例,其中栓塞组5例,夹闭组4例。预后良好(mRS 0~2分)20例,预后不良(mRS≥3分)42例。多因素Logistic回归分析显示栓塞治疗是预后良好的独立预测因素(OR=1.26,95%CI:1.05-3.16,P=0.01),而脑血管痉挛并不是预后的独立影响因素(OR=1.43,95%CI:0.79-1.85,P=0.12)。结论对前循环高分级aSAH病人,血管内栓塞较开颅夹闭更能提高良好预后率,可作为此类疾病的首选治疗措施。

Objective To explore the differences in prognosis between endovascular coiling and surgical clipping for anterior circulation high-grade aSAH.Methods Clinical data of 62 patients with anterior circulation high-grade aSAH were analyzed retrospectively.Endovascular coiling was performed in 36 patients(coiling group)and surgical clipping in 26 patients(clipping group).Cerebral vascular spasm and pneumonia were assessed during hospitalization.Clinical outcomes were assessed by the modified Rankin scale(mRS)3 months after the operation.Results Cerebral vascular spasm occurred in 9 patients after the operation,including 5 in coiling group and 4 in clipping group.Good prognosis(mRS scores 0 to 2 scores)was achieved in 20 patients and poor prognosis(mRS scores greater than or equal to 3 scores)in 42.Multivariable logistic analysis showed that endovascular coiling was an independent predictor for good prognosis(OR=1.26,95% CI:1.05-3.16,P=0.01).While cerebral vascular spasm wasnot an independent predictor for prognosis(OR=1.43,95% CI:0.79-1.85,P=0.12).Conclusions Compared with surgical clipping,endovascular coiling can better improve the good prognosis rate for patients with anterior circulation high grade aSAH,and can be the first choice for such disease.