颅内动脉瘤破裂患者显微动脉瘤夹闭手术时机对疗效及预后的影响

Effect of the timing of microsurgical clipping on clinical efficacy and prognosis of patients with ruptured intracranial aneurysms

目的探究显微动脉瘤夹闭手术时机对颅内动脉瘤(IA)破裂患者临床疗效和预后的影响。方法搜集2020-05—2023-05内江市第一人民医院治疗的96例颅内动脉瘤破裂患者的临床资料,根据患者发病至手术时间分为超早期组(24 h内)49例和早期组(24~72 h)47例,比较2组患者临床疗效、并发症和预后情况。结果2组患者手术完全夹闭率和术中IA再破裂率比较差异无统计学意义(91.84%比85.11%,6.12%比4.26%,P>0.05)。超早期组术前IA再破裂发生率低于早期组(0比12.77%,P<0.05),并发症发生率低于早期组(16.33%比34.04%,P<0.05),预后良好率高于早期组(85.71%比68.09%,P<0.05)。结论在IA破裂24 h内的超早期进行显微动脉瘤夹闭手术疗效优于发病后24~72 h,超早期手术能够降低术前IA再破裂风险,减少并发症,改善患者预后。

Objective To investigate the effect of the timing of microsurgical clipping on clinical efficacy and prognosis of patients with ruptured intracranial aneurysms(IAs).Methods The clinical data of 96 patients with ruptured IAs who were admitted to the Neijiang First People’s Hospital from May 2020 to May 2023 were collected.According to the time from onset to surgery,the patients were divided into ultra early group(49 cases,within 24 hours)and early group(47 cases,24-72 hours).Clinical efficacy,complications and prognosis of the two groups were compared.Results There was no statistically significant difference in the rates of complete clipping and intraoperative re-rupture of IA between the two groups(91.84%vs 85.11%,6.12%vs 4.26%,P>0.05).The incidence of preoperative re-rupture of IA in the ultra early group was lower than that in the early group(0 vs 10.64%,P<0.05).The incidence of complications in the ultra early group was lower than that in the early group(16.33%vs 34.04%,P<0.05).The good prognosis rate in the ultra early group was higher than that in the early group(85.71%vs 68.09%,P<0.05).Conclusion The efficacy of microsurgical clipping within 24 hours after the onset of IA rupture is superior to that at 24-72 hours after onset.Ultra early surgery can reduce the risk of re-rupture of IA before surgery,reduce complications,and improve the prognosis.