高级别组脑动脉瘤破裂患者采取早期与晚期介入栓塞术对栓塞成功率 神经功能及预后的影响

Effect of early and late interventional embolization on success rate,neurological function and prognosis of patients with ruptured cerebral aneurysm(high-level group)

目的探究早期与晚期介入栓塞术治疗脑动脉瘤破裂(Hunt-Hess 4、5级)对患者栓塞成功率、神经功能及预后的影响。方法选取2015年12月至2019年12月在我院进行介入栓塞术治疗的脑动脉瘤破裂患者96例为研究对象,根据患者手术实施时间的不同分为早期组(发病≤72 h进行栓塞治疗)与晚期组(发病>72 h内进行栓塞治疗),各48例。比较2组栓塞疗效、神经功能[改良的Rankin量表(mRS)评分]及预后影响。结果早期组患者栓塞成功率为94%,高于晚期组的77%,差异具有统计学意义(χ^(2)=5.352,P<0.05)。重复测量方差结果显示,2组患者mRS评分的时点、组间、时点与组间的交互效应差异均具有统计学意义(P<0.05)。术后1、2、3个月,早期组患者的mRS评分均低于晚期组(3.11±0.72与3.89±0.78;2.18±0.58与3.05±0.66;1.32±0.35与2.29±0.46,P<0.05)。早期组格拉斯哥预后评分(GOS)预后不良者6例(12%),晚期组GOS预后不良者15例(31%),组间比较差异具有统计学意义(χ^(2)=4.937,P<0.05)。结论早期介入栓塞术治疗脑动脉瘤破裂可有效提高患者栓塞成功率,改善神经功能及预后。

Objective To explore the effect of early and late interventional embolization on the success rate,neurological function and prognosis of cerebral aneurysm rupture (grade Hunt-Hess 4,5) in patients with embolism.Methods Ninety-six patients with cerebral aneurysm rupture treated by interventional embolization in our hospital from December 2015 to December 2019 were selected as the subjects.These patients were divided into early group(embolization within 72 h of onset,n=48) and late group (embolization>72 h of onset,n=48).The efficacy,neurological function (mRS score) and prognostic effects of embolization between the two groups were compared.Results The success rate of embolism in the early group (94%) was higher than that in the late group (77%),the difference was statistically significant (χ^(2)=5.352,P<0.05).Repeated measurements of variance showed that there were significant differences in the time point,group,time point and interaction effect between the two groups (P<0.05).1,2,3 months after surgery,the mRS score of the early group was lower than that of the late group (3.11±0.72 vs 3.89±0.78,2.18±0.58 vs 3.05±0.66,1.32±0.35 vs 2.29±0.46,P<0.05).There were 6 cases with Glasgow Outcome Scale (GOS) poor prognosis in early group (12%),while 15 cases with GOS poor prognosis in advanced group (31%),the difference between the two groups was statistically significant (χ^(2)=4.937,P<0.05).Conclusion Early interventional embolization can effectively improve the success rate,nerve function and prognosis of cerebral aneurysm rupture.