血管介入栓塞术与开颅显微夹闭术治疗动脉瘤性蛛网膜下腔出血的效果

Effects of vascular interventional embolization and craniotomy microclipping on aneurysmal subarachnoid hemorrhage

目的分析血管介入栓塞术与开颅显微夹闭术治疗动脉瘤性蛛网膜下腔出血(a SAH)的效果。方法回顾性分析2021年1月至2021年12月郑州市中心医院91例a SAH患者的临床资料。根据手术方法不同进行分组,其中48例实施血管介入栓塞术,纳入介入组;43例实施开颅显微夹闭术,纳入显微组。比较两组手术疗效,术前、术后3 d免疫指标[免疫球蛋白M(IgM)、免疫球蛋白G(IgG)、免疫球蛋白A(IgA)],术前、术后3 d、术后3个月预后评分[格拉斯哥预后评分(GOS)]、认知功能评分[简易智力状态检查量表(MMSE)],认知功能障碍(POCD)发生情况,及并发症发生情况。结果治疗后,介入组治疗效果优于显微组,差异有统计学意义(Z=2.163,P<0.05)。两组术后3 d IgM、IgG、IgA水平均较术前降低(P<0.05),但介入组高于显微组(P<0.05)。介入组术后3 d、术后3个月GOS评分均高于显微组(P<0.05)。介入组术后3 d、术后3个月MMSE评分均高于显微组(P<0.05);术后3个月内POCD发生率低于显微组(P<0.05)。结论血管介入栓塞术治疗aSAH效果优于开颅显微夹闭术,术后神经功能恢复更佳、并发症更少。

Objective To analyze the effect of vascular interventional embolization and craniotomy microclipping on aneurysmal subarachnoid hemorrhage(aSAH).Methods The clinical data of 91 cases of a SAH in Zhengzhou Central Hospital from January 2021 to December 2021 were analyzed retrospectively.According to different surgical methods,48 cases underwent vascular interventional embolization and were included in the interventional group,43 cases underwent craniotomy and micro clipping,and were included in the microscope group.The curative effects of the two groups were compared,and the immune indexes[immunoglobulin M(IgM),immunoglobulin G(IgG),immunoglobulin A(IgA)]were compared before and 3 days after operation,preoperative,3 days and 3months after operation,the prognosis score[Glasgow prognosis score(GOS)],cognitive function score[mini mental state examination scale(MMSE)],the occurrence of cognitive dysfunction(POCD),and the occurrence of complications were compared.Results After treatment,the therapeutic effect of interventional group was better than that of microscopic group,and the difference was significant(Z=2.163,P<0.05).The levels of IgM,Ig G and IgA in the two groups were lower than those before operation 3 days after operation(P<0.05),but those in the intervention group were higher than those in the microscopy group(P<0.05).The GOS scores of the interventional group were higher than those of the microscopic group at 3 days and 3 months after operation(P<0.05).MMSE scores in the interventional group were higher than those in the microscopic group at 3 days and 3 months after operation(P<0.05).The incidence of POCD within 3 months after operation was lower than that of microscopy(P<0.05).Conclusions Embolization with vascular intervention is superior to craniotomy for the treatment of a SAH,with better postoperative neurological recovery and fewer complications.