超早期介入栓塞破裂颅内动脉瘤治疗体会

Experience of very early interventional embolization for ruptured intracranial aneurysms

目的 研究在破裂出血急性期的颅内动脉瘤患者中,超早期(24 h内)采取介入栓塞治疗的临床疗效。方法 回顾性分析安徽医科大学附属滁州医院(滁州市第一人民医院)神经外科2020年4月—2022年7月收治的51例急诊破裂颅内动脉瘤患者,所有患者均在24 h内采取介入栓塞治疗,对患者临床资料、治疗效果、术后并发症等情况进行总结。结合Raymond分级标准,对术中及术后栓塞情况进行分析,以格拉斯哥预后评分(GOS)为基础,对患者预后情况进行评估。结果 所有患者介入栓塞手术均成功完成,其中RaymondⅠ级栓塞35例,Ⅱ级及Ⅲ级栓塞分别有10例、6例,其中动脉瘤术中破裂3例,予以快速填塞弹簧圈等急救措施后完全栓塞;4例患者发生血栓事件,给予替罗非班溶栓等措施后血流恢复。患者预后情况用GOS评分进行评估,其中良好、轻度残疾、重度残疾、死亡患者数量分别为36例、8例、4例、3例,死亡率为5.88%,总体预后良好。结论 急诊超早期对破裂的颅内动脉瘤患者采取栓塞方法治疗,可以减少动脉瘤二次破裂出血的机会,提高患者生存率及生存质量。

Objective To study the clinical effect of interventional embolization in the very early stage(within 24 hours)in patients with intracranial aneurysms in the acute stage of ruptured hemorrhage.Methods The clinical data of 51 patients with emergency ruptured intracranial aneurysms admitted to the Department of Neurosurgery,The Affiliated Chuzhou Hospital of Anhui Medical University(The First People s Hospital Of Chuzhou)from April 2020 to July 2022 were analyzed retrospectively.All patients underwent interventional embolization treatment within 24 hours,and their clinical data,treatment effects,postoperative complications,and other factors were summarized.Based on the Raymond grading criteria,the intraoperative and postoperative embolism situation were analyzed,and the patient s prognosis based on the Glasgow Outcome Scale(GOS)was evaluated.Results All patients underwent successful interventional embolization surgery,including 35 cases of Raymond gradeⅠembolism,10 cases of gradeⅡand 6 cases of gradeⅢembolism,respectively.Among them,3 cases of aneurysm rupture occurred during surgery,and complete embolization was achieved after emergency measures such as rapid filling of spring coils.Four patients experienced thrombotic events,and blood flow recovered after receiving measures such as thrombolysis with tirofiban.The prognosis of the patients was evaluated by using the GOS score,with 36,8,4,and 3 cases of good,mild disability,severe disability,and death,respectively.The mortality rate was 5.88%,and the overall prognosis was good.Conclusion For ruptured intracranial aneurysms,emergency ultra early interventional embolization can reduce the probability of aneurysm rupture and bleeding again and improve the prognosis of patients.