血管内介入栓塞术与开颅夹闭术治疗颅内动脉瘤患者的效果比较

Comparison of effects of endovascular interventional embolization and craniotomy clipping in treatment of patients with intracranial aneurysms

目的:比较血管内介入栓塞术(IE)与开颅夹闭术(MC)治疗颅内动脉瘤(IA)患者的效果。方法:选取2020年5月至2022年6月该院收治的86例IA患者进行前瞻性研究,按照随机数字表法分为对照组和观察组各43例。对照组接受MC治疗,观察组接受血管内IE治疗。比较两组手术优良率、预后良好率、手术前后氧化应激指标[谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)、丙二醛(MDA)]水平、脑损伤指标[髓磷脂碱性蛋白(MBP)、中枢神经特异性蛋白β(S100β)、神经元烯醇化酶(NSE)]水平和并发症发生率。结果:观察组手术优良率为97.67%,与对照组的93.02%比较,差异无统计学意义(P>0.05);观察组预后良好率为83.72%,高于对照组的65.12%,差异有统计学意义(P<0.05);术后1、3 d,两组SOD、GSH-Px水平均低于术前,但观察组高于对照组,两组MDA、S100β、MBP、NSE水平均高于术前,但观察组低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为2.33%,低于对照组的20.93%,差异有统计学意义(P<0.05)。结论:血管内IE治疗IA患者可提高预后良好率,改善氧化应激指标水平,降低脑损伤指标水平和并发症发生率,优于MC治疗效果。

Objective:To compare effects of endovascular interventional embolization(IE)and craniotomy clipping(MC)in treatment of patients with intracranial aneurysms(IA).Methods:A prospective study was conducted on 86 patients with IA admitted to this hospital from May 2020 to June 2022.They were divided into control group and observation group according to the random number table method,43 cases in each group.The control group was treated with MC,while the observation group was treated with intravascular IE.The excellent and good rate of the surgery,the good prognosis rate,the oxidative stress index levels[glutathione peroxidase(GSH-Px),superoxide dismutase(SOD),malondialdehyde(MDA)]before and after the surgery,the brain injury index levels[myelin basic protein(MBP),central nervous system specific protein β(S100β),neuron enolase(NSE)],and the incidence of complications were compared between the two groups.Results:The excellent and good rate of the surgery in the observation group was 97.67%,compared with 93.02% in the control group,and the difference was not statistically significant(P>0.05).The good prognosis rate of the observation group was 83.72%,which was higher than 65.12% of the control group,and the difference was statistically significant(P<0.05).At 1 and 3 days after the surgery,the levels of SOD and GSH-Px in the two groups were lower than those before the surgery,but those in the observation group were higher than those in the control group;the levels of MDA,S100β,MBP and NSE in the two groups were higher than those before the surgery,but those in the observation group were lower than those in the control group;and the differences were statistically significant(P<0.05).Further,the incidence of complications in the observation group was 2.33%,which was lower than 20.93% in the control group,and the difference was statistically significant(P<0.05).Conclusions:Intravascular IE in the treatment of the IA patients can improve the good prognosis rate,improve the levels of oxidative stress indexes,and reduce the levels of brain injury indexes and the incidence of complications.Moreover,it is superior to MC treatment.