不同时机行血管内介入栓塞治疗对老年颅内动脉瘤破裂出血患者预后的影响

Impact of intravascular embolization therapy at different times on prognosis of elderly patients with IA rupture and bleeding

目的探讨不同时机行血管内介入栓塞治疗对老年颅内动脉瘤破裂出血患者预后的影响。方法回顾性收集2019年1月至2022年12月普洱市人民医院神经外科收治的老年颅内动脉瘤破裂出血患者156例,均行血管内介入栓塞治疗,根据行血管内介入栓塞的时机,将患者分为超早期组66例和延迟组90例。记录患者的Hunt-Hess分级、动脉瘤部位、脑脊液置换;检查栓塞情况和栓塞治疗成功率;比较2组预后情况、美国国立卫生研究院卒中量表(NIHSS)评分及改良的Rankin量表(mRS)评分。结果2组脑血管痉挛、意识障碍、肢体活动障碍、再出血比例及mRS评分比较无显著差异(P>0.05),超早期组脑积水比例显著低于延迟组(4.55%vs15.56%,P<0.05)。2组治疗前NIHSS评分比较无显著差异(P>0.05),2组治疗后NIHSS评分均低于治疗前(P<0.05),且超早期组治疗后NIHSS评分显著低于延迟组[(6.62±1.25)分vs(7.82±1.35)分,P<0.01]。结论超早期行血管内介入栓塞治疗可以有效降低老年颅内动脉瘤破裂出血患者的脑积水发生率并改善患者神经功能。

Objective To explore the impact of different times for endovascular embolization thera-py on the prognosis of elderly patients with intracranial aneurysm(A)rupture and bleeding.Methods Clinical data of 156 elderly patients with 1A rupture and bleeding admitted to our hos-pital from January 2019 to December 2022 were collected and analyzed retrospectively.All of them underwent intravascular embolization treatment.According to the timing of intravascular emboli-zation,they were divided into super early group(within 24 h from onset,n=66)and delayed group(in 24 h after onset,n=90).The Hunt-Hess grade,aneurysm location,cerebrospinal fluid exchange,embolization situation and success rate of embolization treatment were observed and re-corded.The prognosis of the two groups were evaluated with N1HSS score and mRS score.Results In terms of prognosis,no significant differences were observed in cerebrovascular spasm,disorders of consciousness,limb movement disorder,proportion of rebleeding,and mRS score between the two groups(P>0.05).The ratio of hydrocephalus was obviously lower in the super early group than the delayed group(4.55%vs 15.56%,P<0.05).Though no statistical difference was seen in the pre-operative N1HSS score between the two groups(P>0.05),the score was declined after treatment(P<0.05),with that of the super early group notably lower than that in the delayed group(6.62±1.25 vs 7.82±1.35,P<0.01).Conclusion Super early endovascular embolization can eefectively reduce the incidence of hydrocephalus and improve neurological function in elderly patients with 1A rupture and bleeding.