外科治疗高分级动脉瘤性蛛网膜下腔出血的随访分析

Follow-up analysis of surgical treatment for poor-grade aneurysmal subarachnoid hemorrhage

摘要:

目的 探讨高分级颅内动脉瘤的治疗方式和影响预后的因素。方法 回顾性分析南方医科大学第三附属医院神经外科2011年4月至2017年7月收治的24例高级别颅内动脉瘤患者的临床资料和影像资料，采用mRS量表评价患者的预后，通过单因素t检验和卡方检验分析影响预后的因素。结果 预后良好12例，预后差12例。单因素分析显示患者年龄≥65岁（P=0.028）、高血压病史（P=0.041）、动脉瘤直径>5mm（P=0.041）、急性脑积水（P=0.028）与预后不良有关。Hunt-HessⅣ级患者不同手术时机分组间死亡率差异有统计学意义（P=0.018）；Hunt-HessⅤ级患者不同手术时机分组间死亡率差异无统计学意义（P=0.505）。结论 通过积极的治疗，高级别动脉瘤性蛛网膜下腔出血患者可以取得较好的预后。患者的年龄、高血压病史、急性脑积水、动脉瘤大小与预后相关。超早期手术有助于降低Hunt-HessⅣ级患者死亡率。

Abstract:

Objective To investigate the treatment and prognostic factors for poor-grade intracranial aneurysms.Methods A retrospective analysis was performed on the clinical data and imaging data of 24 patients with poor-grade intracranial aneurysms who were admitted to the Department of Neurosurgery, Third Affiliated Hospital of Southern Medical University, from April 2011 to July 2017. The modified Rankin Scale (mRS) was used to assess the prognosis of the patients. The univariate t test and chi-square test were used to identify the prognostic factors.Results According to the mRS score, 12 patients had a good prognosis and 12 patients had a poor prognosis. The univariate analysis showed that a poor prognosis was associated with age ≥ 65 years (P=0.028), a history of hypertension (P=0.041), aneurysm diameter >5 mm (P=0.041), and acute hydrocephalus (P=0.028). There was a significant difference in mortality rate between the Hunt-Hess IV patients with intracranial aneurysms undergoing surgery at different times (P=0.018). However, there was no significant difference in mortality rate between the Hunt-Hess V patients with intracranial aneurysms undergoing surgery at different times (P=0.505).Conclusions For poor-grade aneurysmal subarachnoid hemorrhage, early aggressive surgical treatment can achieve satisfactory efficacy. The prognosis is associated with the age of patients, history of hypertension, the presence or absence of acute hydrocephalus, and aneurysm size. The surgery in very early stage can help reduce the mortality rate of Hunt-Hess IV patients with intracranial aneurysms.