重症动脉瘤性蛛网膜下腔出血14例的显微外科手术疗效

Microsurgical treatment of severe aneurysmal subarachnoid hemorrhage:an analysis of 14 cases

目的分析重症动脉瘤性蛛网膜下腔出血(SaSAH)患者行显微外科手术的治疗效果。方法回顾性分析2017年12月至2019年11月首都医科大学附属北京朝阳医院急诊收治的14例SaSAH患者,收集一般资料、Hunt-Hess分级、格拉斯哥昏迷评分(GCS)、再出血时间、手术时间、检查方法、动脉瘤大小、预后及术后随访情况。结果入组14例SaSAH患者,男5例,女9例,Hunt-HessⅣ级8例,Ⅴ级6例。7例入院后再出血,再出血距首发症状时间平均为11.21 h。13例术前经计算机断层扫描血管造影(CTA)或数字减影血管造影(DSA)明确诊断颅内动脉瘤破裂出血。14例患者明确诊断后均接受开颅显微镜下动脉瘤夹闭术。其中颞叶沟回疝5例,单纯大脑镰下疝3例,脑疝患者手术中均去除骨瓣。术后6个月随访,14例患者中格拉斯哥预后评分(GOS)4分2例,3分3例,2分7例,1分2例。结论24 h内治疗SaSAH责任动脉瘤是防治颅内再出血、降低死亡率、改善预后的重要原则。显微外科手术仍然是治疗SaSAH的重要方法,尤其对于存在颅内血肿、进行性颅内压升高的SaSAH患者。

Objective To analyze the therapeutic effect of microsurgery on patients with severe aneurysmal subarachnoid hemorrhage(SaSAH).Methods A retrospective analysis was conducted on 14 SaSAH patients admitted to Beijing Chao-Yang Hospital,Capital Medical University from December 2017 to November 2019.General information,Hunt Hess grading,Glasgow Coma Scale(GCS),time of rebleeding,surgery time,examination method,aneurysm size,prognosis,and postoperative follow-up were collected.Results A total of 14 patients with SaSAH were enrolled,including 5 males and 9 females,8 patients with Hunt-Hess gradeⅣand 6 with gradeⅤ.Seven cases experienced rebleeding after admission,with an average time between the onset of symptoms and rebleeding being 11.21 hours.Intracranial aneurysm rupture was confirmed by computed tomography angiography(CTA)or digital subtraction angiography(DSA)before operation in 13 cases.All 14 patients underwent microsurgical aneurysm clipping after definite diagnosis.There were 5 cases of transtentorial herniation and 3 cases of subfalcine herniation.Bone flaps were removed during surgery for all patients with cerebral herniation.In 14 cases,Glasgow prognostic score(GOS)was 4 in 2 cases,3 in 3 cases,2 in 7 cases,and 1 in 2 case at 6 months follow-up.Conclusion Treating SaSAH responsible aneurysms within 24 hours is an important principle for preventing intracranial rebleeding,reducing mortality,and improving prognosis.Microsurgery remains an important method for treating SaSAH,especially for patients with intracranial hematoma and progressive intracranial hypertension.