双微导管血管介入术治疗老年颅内动脉瘤的疗效

Efficacy of dual microcatheter vascular interventional therapy for intracranial aneurysms in elderly patients

目的探讨双微导管血管介入术调节脑损伤标志物和脑氧代谢治疗老年颅内动脉瘤的疗效。方法选择2018年1月至2024年2月济南市第三人民医院神经外科住院的老年颅内动脉瘤患者240例,根据治疗方法分为研究组120例和对照组120例。研究组采取双微导管技术血管内栓塞,对照组采取自我膨胀型支架结合弹簧圈。比较2组治疗效果、预后、精神状态恢复情况、脑损伤标志物、脑氧代谢情况及不良反应。结果2组完全栓塞、次全栓塞和不完全栓塞比较,差异无统计学意义(P>0.05)。研究组完全康复率明显高于对照组,差异有统计学意义(74.2%vs 55.0%,P=0.019)。2组治疗后记忆能力、回忆功能、计算能力、注意力的集中能力、定向功能、语言功能评分较治疗前明显升高,差异有统计学意义(P<0.01),且研究组治疗后记忆能力、回忆功能、计算能力,注意力的集中能力、定向功能、语言功能评分明显高于对照组,差异有统计学意义(P<0.01)。2组治疗后1 d动脉血氧分压、动脉血氧、颈内动脉静脉球部氧差值、脑氧摄取率较治疗前明显降低,颈内静脉氧分压、颈内静脉氧较治疗前明显升高,差异有统计学意义(P<0.01);与治疗后1 d比较,2组治疗后6个月动脉血氧分压、动脉血氧、颈内动脉静脉球部氧差值、脑氧摄取率明显升高,差异有统计学意义(P<0.01)。研究组治疗后1 d动脉血氧分压、动脉血氧、颈内静脉氧、颈内动脉静脉球部氧差值、脑氧摄取率明显高于对照组,颈内静脉氧分压明显低于对照组,治疗后6个月动脉血氧分压、动脉血氧、颈内动脉静脉球部氧差值、脑氧摄取率明显高于对照组,颈内静脉氧分压、颈内静脉氧明显低于对照组,差异有统计学意义(P<0.01)。2组脑梗死、血管痉挛、血管再狭窄、短暂性脑出血比例比较,差异无统计学意义(P>0.05)。结论双微导管血管介入术可以通过调节脑损伤标志物和脑氧代谢指标,进一步提升老年颅内动脉瘤的治疗效果。

Objective To investigate the therapeutic efficacy of double microcatheter vascular intervention on senile intracranial aneurysms by adjusting brain injury markers and cerebral oxygen metabolism.Methods A total of 240 elderly patients with intracranial aneurysms diagnosed and treated in our hospital from January 2018 to February 2024 were recruited,and according to their treatment methods,they were divided into double microcatheter endovascular embolization group(study group,120 cases)and self-expanding stents combined with spring coils group(control group,120 cases).Therapeutic efficacy,prognosis,recovery of mental state,changes in brain injury markers,cerebral oxygen metabolism,and adverse reactions were compared between the two groups.Results There were no significant differences between the two groups in terms of the ratios of total embolization,subtotal embolization and incomplete embolization(P>0.05).The study group obtained significantly higher complete recovery rate than the control group(74.2%vs 55.0%,P=0.019).The scores of memory ability,recall function,computing ability,concentration ability of attention,orientation function and language function were obviously improved in both groups after treatment(P<0.01),and above scores were statistically higher in the study group than the control group(P<0.01).In 1 d after treatment,arterial blood oxygen pressure,arterial blood oxygen,oxygen differences of internal carotid arterial and venous bulb,and cerebral oxygen uptake rate were significantly decreased,while oxygen partial pressure of internal jugular vein and internal jugular venous oxygen were obviously increased in both groups(P<0.01).What's more,arterial blood oxygen partial pressure,arterial blood oxygen,oxygen difference of internal carotid arterial and venous bulb and cerebral oxygen uptake rate were significantly increased in the two groups at 6 months after treatment than 1 d after treatment(P<0.01).The study group obtained significantly higher partial pressure of arterial blood oxygen,arterial blood oxygen,internal jugular vein oxygen,internal jugular venous oxygen difference and cerebral oxygen uptake rate,while lower partial pressure of internal jugular venous oxygen than the control group in 1 d after treatment,and had notably higher partial pressure of arterial blood oxygen,arterial blood oxygen,oxygen difference of internal carotid arterial and venous bulb and cerebral oxygen uptake rate,and decreased partial pressure of jugular vein oxygen and jugular venous oxygen than the control group in 6 months after treatment(P<0.01).No statistical significances were observed in the proportions of cerebral infarction,vasospasm,vasorestenosis and transient cerebral hemorrhage between the two groups(P>0.05).Conclusion Double microcatheter vascular intervention can further improve the therapeutic efficacy of elderly intracranial aneurysms by adjusting brain injury markers and brain oxygen metabolism indicators.