破裂颅内动脉瘤的急诊治疗

Emergency treatment of intracranial aneurysm rupture

目的:探讨破裂颅内动脉瘤行急诊外科治疗的疗效。方法:回顾147例破裂颅内动脉瘤患者,急诊血管内治疗84例85个动脉瘤,显微手术组63例64个动脉瘤,以出院mRS分级0~2级为预后良好,结合年龄及Hunt-Hess分级对比两种术式预后。结果:两种术式总体预后良好率差异无统计学意义(P>0.05)。当患者≥65岁时,血管内治疗预后良好率显著好于显微手术(P<0.05);当患者<65岁时预后良好率差异无统计学意义(P>0.05)。无论Hunt-Hess 1~3级和4~5级,两种术式预后良好率差异均无统计学意义(P>0.05)。血管内治疗总体并发症及癫痫发生率显著低于显微手术。结论:显微手术和血管内治疗是破裂颅内动脉瘤急诊治疗的有效方法,血管内治疗手术风险更低,尤其适合老年及后循环动脉瘤。

Objective:To explore the curative effect of emergency surgical treatment of intracranial aneurysm rupture.Methods:147 cases with intracranial aneurysm rupture were reviewed.84 cases with 85 aneurysms were treated with emergency endovascular treatment.Microscopic surgery group had 63 cases with 64 aneurysms.According to discharge mRS classification,0~2 grade was favourable prognosis.The prognosises of two kinds of operation were compared with age and Hunt-Hess classification.Results:The overall good prognosis rate of two kinds of operation had no statistical difference(P>0.05).When the patients over 65 years old,the good prognosis rate of endovascular treatment was significantly better than microsurgery(P<0.05).When the patients under 65 years old,the good prognosis rate had no significant difference(P>0.05).Both Hunt-Hess 1~3 and 4~5,there was no significant difference between the good prognosis rates of two kinds of operation(P>0.05).The incidence rates of complications and epilepsy of endovascular treatment were significantly lower than those of microsurgery(P<0.05).Conclusion:Microsurgery and endovascular treatment are the effective method for the emergency treatment of intracranial aneurysm rupture.The endovascular treatment has low operation risk.It is especially for the elderly and the posterior circulation aneurysms.