早期神经介入栓塞治疗老年破裂颅内动脉瘤患者的临床优势

Clinical advantages of early nerve embolization for elderly patients with ruptured intracranial aneurysms

目的探析早期神经介入栓塞在老年破裂颅内动脉瘤患者治疗中的应用效果。方法连续收集2014年1月至2020年10月在解放军总医院第一医学中心神经内科住院的老年破裂颅内动脉瘤患者68例,采用随机数字表法分为对照组(32例)和观察组(36例)。观察组于早期实施神经介入栓塞治疗(动脉瘤破裂后24 h内),对照组于非早期神经介入治疗(动脉瘤破裂24 h后),比较2组卧床时间、住院时间、美国国立卫生研究院卒中量表(NIHSS)评分、并发症发生率及栓塞程度。结果观察组卧床时间、住院时间显著短于对照组[(4.95±1.15)d vs(6.42±0.89)d,(10.21±2.34)d vs(14.57±2.31)d,P=0.000];观察组完全栓塞比例显著高于对照组(88.89%vs 68.75%,P=0.040);2组入院时及术后2周NIHSS评分、肺部感染、再破裂出血、下肢静脉血栓、脑水肿发生率、大部分栓塞、部分栓塞比例比较,差异无统计学意义(P>0.05)。结论早期神经介入栓塞术在老年破裂颅内动脉瘤患者治疗中应用效果显著,其有助于患者神经功能、生活自理能力改善,且能够降低并发症发生率。

Objective To explore the efficacy of early nerve embolization in the treatment of ruptured intracranial aneurysm in the elderly patients.Methods Sixty-eight consecutive elderly patients with ruptured intracranial aneurysms admitted to Department of Neurology of the First Medical Center of Chinese PLA General Hospital from January 2014 to October 2020 were recruited and then randomly divided into control group(n=32)and observation group(n=36).The observation group was treated with early interventional nerve embolization(within 24 h after aneurysm rupture),while the control group was treated with non-early interventional nerve embolization(24 h after aneurysm rupture).Bed time,hospital stay,NIHSS score,incidence of complications and extent of embolization were compared between the two groups.Results The bed time and length of hospital stay were significantly shorter in the observation group than the control group(4.95±1.15 d vs 6.42±0.89 d,10.21±2.34 d vs 14.57±2.31 d,P=0.000).The proportion of complete embolization in the observation group was significantly higher than that in the control group(88.89%vs 68.75%,P=0.040).There were no statistical differences in NIHSS score,incidences of pulmonary infection,rerupture hemorrhage,lower extremity venous thrombosis,hydrocephalus,and proportions of most and partial embolization between the two groups at admission and 2 weeks after surgery(P>0.05).Conclusion Early nerve embolization is effective in the treatment of elderly patients with ruptured intracranial aneurysms,which can improve the neurological function and self-care ability and reduce the incidence of complications.