颅内动脉瘤破裂的超早期血管内介入治疗分析

Interventional treatment for ruptured intracranial aneurysms in ultraearly period

目的 探讨颅内动脉瘤破裂超早期血管内介入治疗的优势及可行性。方法 2 7例不同部位颅内动脉瘤 (30个 )患者 ,一经全脑数字减影动脉造影术 (DSA)检查证实 ,即在 4 8h内、气管内插管全麻下行血管内介入治疗。术前Hunt Hess分级 :Ⅰ级～Ⅱ级 16例 ,Ⅲ级 7例 ,Ⅳ级 3例 ,Ⅴ级 1例 ;其中采用机械性可脱性微弹簧圈 (MDS)栓塞治疗 2例 ,电解式可脱性微弹簧圈 (GDC)栓塞治疗2 5例。结果 术后恢复良好者 2 4例 ;出现一过性偏瘫、失语 1例 ,单纯运动性失语 1例 ,均于 1个月后逐渐恢复 ;死亡 1例 (Hunt HessⅤ级 )。结论 对Hunt Hess分级Ⅰ～Ⅳ级的患者实施超早期介入手术治疗可避免动脉瘤再次破裂出血 ,减少脑血管痉挛 ,降低死亡率 ;并具有微创、恢复时间短、术后并发症少等优势。

Objective To discuss the superiority and possibility of the interventional treatment for ruptured intracranial aneurysms in ultraearly period. Methods 27 cases suffered from intracranial aneurysms were treated by interventional therapy under general anesthesia within 48 hours from SAH when the diagnosis of intracranial aneurysms was confirmed by DSA. Preoperative Hunt-Hess grade:16 cases were Ⅰ～Ⅱ, 7 cases were Ⅲ, 3 cases were Ⅳ and 1 case was Ⅴ. 2 cases were treated with MDS, 25 cases were treated with GDC. Results 24 cases were excellent after operation. Hemiplegia and anepia was found in 1case only and Broca's aphasia 1 case after operation. But these two patients were gradually recovered 1 month later. 1 case died because the Hunt-Hess was Ⅴ grade. Conclusions The treatment for the patients from SAH Ⅰ～Ⅳ grade in ultraearly period can avoid rebleeding from aneurysms, decreased the ratio of vasospasm and mortality and has the advantage of mini-invasive and lower complications.