颅内动脉瘤破裂后早期神经介入栓塞的疗效及对神经功能的影响

Effect of early nerve interventional embolization after intracranial aneurysm rupture and its influence on nerve function

目的探究颅内动脉瘤(IA)破裂后早期神经介入栓塞的疗效及对神经功能的影响。方法2020年1月~2023年1月行神经介入栓塞治疗的IA破裂病人100例,根据手术时机不同分为两组,对照组49例,于IA破裂后24~72小时手术;研究组51例,于IA破裂后24小时内手术。比较两组栓塞成功率、血清炎症-应激因子[白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α、D-二聚体(D-D)、丙二醛(MDA)],脑血管痉挛(CVS)相关因子[缺氧诱导因子(HIF)-1α,可溶性细胞间黏附分子(SICAM)-1,半胱氨酸天冬氨酸蛋白水解酶(Caspase)-3],神经功能(NIHSS评分),日常生活能力(BI评分),并发症(脑血管痉挛)及近期预后。结果研究组栓塞成功率为94.12%,高于对照组的79.59%,两组比较差异有统计学意义(P<0.05);研究组术后第1、3、7天血清IL-6分别为(18.06±5.11)ng/L、(17.15±4.60)ng/L、(16.37±4.35)ng/L,对照组分别为(23.18±5.92)ng/L、(21.23±5.54)ng/L、(20.16±5.29)ng/L,TNF-α分别为(32.01±7.19)ng/ml、(30.67±6.85)ng/ml、(29.45±6.63)ng/ml,对照组分别为(39.01±8.20)ng/ml、(36.22±7.53)ng/ml、(35.01±7.12)ng/ml,D-D分别为(27.19±4.89)μg/ml、(26.20±4.71)μg/ml、(25.81±4.39)μg/ml,对照组分别为(32.06±5.94)μg/ml、(31.18±5.49)μg/ml、(30.26±5.61)μg/ml,MDA分别为(2.81±0.83)μmol/ml、(2.53±0.75)μmol/ml、(2.46±0.71)μmol/ml,对照组分别为(4.02±1.01)μmol/ml、(3.84±0.91)μmol/ml、(3.59±0.86)μmol/ml,两组比较差异有统计学意义(P<0.05);术后第1、3、7天,研究组血清HIF-1α分别为(95.16±8.21)pg/m、(93.25±7.94)pg/m、(92.54±7.80)pg/m,对照组分别为(102.31±8.56)pg/m、(100.27±8.19)pg/m、(99.65±7.92)pg/m,SICAM-1分别为(620.15±78.92)ng/ml、(616.37±75.28)ng/ml、(610.92±73.69)ng/ml,对照组分别为(683.19±80.24)ng/ml、(680.24±78.51)ng/ml、(675.31±75.92)ng/ml,Caspase-3分别为(645.13±88.61)mg/ml、(640.21±85.76)mg/ml、(633.79±82.65)mg/ml,对照组分别为(720.13±90.54)mg/ml、(717.03±88.65)mg/ml、(712.81±85.04)mg/ml,两组比较差异有统计学意义(P<0.05);研究组术后1个月、3个月NIHSS评分分别为(5.20±1.37)分、(5.03±1.32)分,对照组分别为(6.31±1.50)分、(6.17±1.45)分;BI评分分别为(78.01±5.73)分、(79.12±5.81)分,对照组分别为(72.69±5.50)分、(73.24±5.72)分,两组比较差异有统计学意义(P<0.05);研究组并发症发生率为7.84%,低于对照组的22.45%,两组比较差异有统计学意义(P<0.05);研究组预后良好率为82.35%,高于对照组的61.22%,两组比较差异有统计学意义(P<0.05)。结论IA破裂后24小时内行神经介入栓塞的疗效显著,能更有效改善病人神经功能和预后。

Objective To investigate the effect of early nerve interventional embolization after ruptured intracranial aneurysm(IA)and its effect on nerve function.Methods A total of 100 patients with ruptured IA who underwent neurointerventional embolization in our hospital from January 2020 to January 2023 were selected and divided into two groups according to the timing of surgery.The control group(n=49)underwent surgery 24-72 hours after rupture of IA,while the study group(n=51)underwent surgery within 24 hours after rupture of IA.The success rate of embolization,serum inflammatory stress factor[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),D-dimer(D-D),malondialdehyde(MDA)],cerebrovascular spasticity(CVS)related factors[hypoxia-inducing factor 1α(HIF-1α)],soluble intercellular adhesion molecule-1(SICAM-1),cysteine aspartate proteolytic enzyme 3(Caspase-3),neurological function(NIHSS score),capacity of daily living(BI score),complications(cerebral vasospasm)and short-term prognosis were compared between the two groups.Results The success rate of embolization in the study group was 94.12%,which was higher than that in the control group(79.59%)(P<0.05).The serum IL-6 levels in the study group on day 1,3,and 7 after surgery were(18.06±5.11)ng/L,(17.15±4.60)ng/L,and(16.37±4.35)ng/L,respectively,while those in the control group were(23.18±5.92)ng/L,(21.23±5.54)ng/L,and(20.16±5.29)ng/L,respectively,the TNF-αlevels were(32.01±7.19)ng/ml,(30.67±6.85)ng/ml,and(29.45±6.63)ng/ml,respectively,while those in the control group were(39.01±8.20)ng/ml,(36.22±7.53)ng/ml,and(35.01±7.12)ng/ml,respectively,the D-D levels were(27.19±4.89)μg/ml,(26.20±4.71)μg/ml,and(25.81±4.39)μg/ml,respectively,while those in the control group were(32.06±5.94)μg/ml,(31.18±5.49)μg/ml,and(30.26±5.61)μg/ml,respectively,the MDA levels were(2.81±0.83)μmol/ml,(2.53±0.75)μmol/ml,and(2.46±0.71)μmol/ml,respectively,while those in the control group were(4.02±1.01)μmol/ml,(3.84±0.91)μmol/ml,and(3.59±0.86)μmol/ml,respectively,and the differences between the two groups were statistically significant(P<0.05);on postoperative day 1,3,and 7,the serum HIF-1αlevels in the study group were(95.16±8.21)pg/ml,(93.25±7.94)pg/ml,and(92.54±7.80)pg/ml,respectively,while those in the control group were(102.31±8.56)pg/ml,(100.27±8.19)pg/ml,and(99.65±7.92)pg/ml,respectively,the SICAM-1 levels were(620.15±78.92)ng/ml,(616.37±75.28)ng/ml,and(610.92±73.69)ng/ml,respectively,while those in the control group were(683.19±80.24)ng/ml,(680.24±78.51)ng/ml,and(675.31±75.92)ng/ml,respectively,the caspase-3 levels were(645.13±88.61)mg/ml,(640.21±85.76)mg/ml,and(633.79±82.65)mg/ml,respectively,while those in the control group were(720.13±90.54)mg/ml,(717.03±88.65)mg/ml,and(712.81±85.04)mg/ml,respectively,and there were significant differences between the two groups(P<0.05);the NIHSS scores of the study group at 1 month and 3 months after surgery were(5.20±1.37)scores and(5.03±1.32)scores,respectively,while those of the control group were(6.31±1.50)scores and(6.17±1.45)scores,respectively,the BI scores were(78.01±5.73)scores and(79.12±5.81)scores,respectively,while those of the control group were(72.69±5.50)scores and(73.24±5.72)scores,respectively,and the difference between the two groups was statistically significant(P<0.05).The incidence of complications in the study group was 7.84%,which was lower than that of the control group(22.45%)(P<0.05).The good prognosis rate in the study group was 82.35%,which was higher than that of the control group(61.22%)(P<0.05).Conclusion Neurological intervention and embolization within 24 hours after rupture of IA has significant therapeutic effects and can more effectively improve patients’neurological function and prognosis.