血管介入栓塞术和显微瘤颈夹闭术治疗动脉瘤性蛛网膜下腔出血的有效性及安全性

Effectiveness and safety of vascular intervention embolization and microsurgical neck clipping for the treatment of aneurysmal subarachnoid hemorrhage

目的分析比较血管介入栓塞术和显微瘤颈夹闭术在动脉瘤性蛛网膜下腔出血(aSAH)患者中的效果。方法选取2020年6月至2023年6月江西省宜春市人民医院收治的81例aSAH患者作为研究对象,按随机数字表法分为对照组(40例)与观察组(41例)。对照组与观察组分别采用显微瘤颈夹闭术与血管介入栓塞术,术后随访3个月。比较两组的围手术期指标、免疫功能、神经功能、认知功能、并发症。结果观察组术中出血量少于对照组,手术、住院时间短于对照组,并发症总发生率低于对照组,差异有统计学意义(P<0.05);术前,两组各免疫功能指标、美国国立卫生研究院卒中量表(NIHSS)、简易智能量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分相比,差异无统计学意义(P>0.05);术后,观察组各免疫功能指标、MMSE评分、MoCA评分高于对照组,NIHSS评分低于对照组,差异有统计学意义(P<0.05)。结论血管介入栓塞术具有更小的创伤,能够减轻对aSAH患者免疫功能的损伤,可改善神经、认知功能,且并发症少,具有一定的应用价值,临床可推广应用。

Objective To analyze and compare the effects of vascular interventional embolization and microsurgical neck clipping in patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of eighty-one aSAH patients admitted to Yichun People's Hospital from June 2020 to June 2023 were selected as the study objects,and they were divided into control group(40 cases)and observation group(41 cases)according to random number table method.The control group was treated with microsurgical neck clipping,and the observation group was treated with vascular interventional embolization.The patients were followed up for 3 months.The perioperative indexes,immune function,neurological function,cognitive function and complications were compared between the two groups.Results The intraoperative blood loss of the observation group was less than the control group,the operation and hospitalization time were shorter than the control group,and the total incidence of complications was lower than the control group,and the difference was statistically significant(P<0.05).Before operation,there were no significant differences in immune function indexes,National Institute of Health stroke scale(NIHSS),mini-mental state examination(MMSE)and Montreal cognitive assessment(MOCA)scores between the two groups(P>0.05).After operation,the immune function indexes,MMSE score and MOCA score of the observation group were higher than those of the control group,while the NIHSS score of the observation group was lower than that of the control group,and the difference was statistically significant(P<0.05).Conclusion Vascular interventional embolization has less trauma,can reduce the damage to the immune function of aSAH patients,can improve the neurological and cognitive functions,and has less complications,so it has certain application value and can be popularized in clinic.