高级别动脉瘤性蛛网膜下腔出血伴脑内血肿临床预后分析

Prognostic analysis of patients with high⁃grade aneurysmal subarachnoid hemorrhage complicated with acute intracranial hematoma

目的 对比分析伴不同脑内血肿量的高级别动脉瘤性蛛网膜下腔出血(aSAH)患者的临床预后。方法 纳入2013年9月至2020年12月在江苏省苏北人民医院住院治疗的211例高级别aSAH患者,根据脑内血肿量分为无血肿组(105例)、血肿量<50 ml组(69例)和血肿量≥50 ml组(37例),均行动脉瘤夹闭术或动脉瘤栓塞术,术后6个月采用改良Rankin量表(mRS)评估临床预后并记录并发症发生率。结果 共211例患者中139例(65.88%)行动脉瘤夹闭术,72例(34.12%)行动脉瘤栓塞术,除3例动脉瘤夹闭术患者因术中恶性脑膨出行去骨瓣减压术外,其余208例均成功夹闭或栓塞动脉瘤,术后无一例发生动脉瘤再次破裂出血。预后良好58例(27.49%)、预后不良59例(27.96%)、死亡94例(44.55%),3组患者临床预后差异具有统计学意义(χ^(2)=7.424,P=0.024),仅血肿量≥50 ml组临床预后差于无血肿组(Z=-2.655,P=0.008)。总体并发症发生率为95.73%(202/211),无血肿组为95.24%(100/105)、血肿量<50 ml组为95.65%(66/69)、血肿量≥50 ml组为97.30%(36/37),3组并发症发生率差异无统计学意义(χ^(2)=0.284,P=0.867)。结论 伴脑内血肿的高级别aSAH患者预后较差,特别是血肿量≥50 ml患者,术后病死率较高。

Objective To analyze the clinical prognosis of high-grade aneurysmal subarachnoid hemorrhage(aSAH)patients with different amounts of hematoma.Methods A total of 211 patients with high-grade aSAH hospitalized in Norhern Jiangsu People's Hospital from September 2013 to December 2020 were included.According to the intracerebral hematoma volume,they were divided into non-hematoma group(n=105),hematoma volume<50 ml group(n=69)and hematoma volume≥50 ml group(n=37).All of them underwent aneurysm clipping or embolization.The modified Rankin Scale(mRS)was used to evaluate the clinical prognosis 6 months after surgery.Results Among 211 cases,139(65.87%)underwent aneurysm clipping and 72(34.12%)underwent aneurysm embolization.Except for 3 patients who failed to successfully clamp and underwent decompression with bone flap due to intraoperative malignant encephaloceles,the remaining 208 patients were successfully clipped,and no aneurysms ruptured and bled again after surgery.There were 58 patients(27.49%)with good prognosis,59 patients(27.96%)with poor prognosis,and 94 patients(44.55%)with death.The difference in neurological function prognosis among the 3 groups was statistically significant(χ^(2)=7.424,P=0.024).Among them,the mortality rate in hematoma volume≥50 ml group was higher than that in non-hematoma group(Z=-2.655,P=0.008).The incidence of complication was 95.73%(202/211)in all patients,including 95.24%(100/105)in non-hematoma group,95.65%(66/69)in hematoma volume<50 ml group,and 97.30%(36/37)in hematoma volume≥50 ml group.The difference in complication among the 3 groups was not statistically significant(χ^(2)=0.284,P=0.867).Conclusions The prognosis of high-grade aSAH patients with intracerebral hematoma is poorer,especially in high-grade aSAH patients with hematoma volume≥50 ml,and have a higher mortality rate.