Hunt-HessⅤ级脑动脉瘤破裂的急诊手术治疗

Effect of emergency surgical treatment of patients with Hunt-Hess grade V ruptured cerebral aneurysms

摘要:

目的 探讨Hunt-HessⅤ级脑动脉瘤破裂患者急诊手术治疗的意义及效果。方法 作者自2007年1月起，对Hunt-HessⅤ级脑动脉瘤破裂出血，昏迷，单侧或双侧瞳孔散大，没有行脑血管造影的7例患者。根据头颅CT所示出血部位，行针对性的急诊开颅手术探查，清除血肿，夹闭动脉瘤。术后根据脑组织塌陷的情况，决定是否去骨瓣减压。结果 7例患者经急诊开颅手术治疗后，痊愈1例；生活自理2例；植物生存3例；术后死亡1例。植物生存的3例患者，其中2例分别于术后3个月、1年死于肺部感染。结论 作者认为对Hunt-HessⅤ级动脉瘤破裂患者进行急诊手术治疗，可使部分患者的预后得到显著改善；较采取保守、观察等待的方法要积极有效。

Abstract:

Objective To investigate the significance and clinical effect of emergency surgical treatment of patients with Hunt-Hess grade V ruptured cerebral aneurysms.Methods Since January 2007, 7 patients with unilateral or bilateral pupil dilation and Hunt-Hess grade V ruptured cerebral aneurysms who were in a coma and did not undergo cerebral angiography were enrolled. According to the bleeding sites on head CT scan, targeted emergency craniotomy was performed to remove the hematoma and clip the aneurysms. The collapse of brain tissue was observed to decide whether to perform decompressive craniectomy or not.Results Of all 7 patients, 1 was cured, 2 were able to take care of themselves, 3 were in a vegetative state, and 1 died after surgery. Among the 3 patients who were in a vegetative state, 2 died of pulmonary infection at 3 months and 1 year after surgery, respectively.Conclusions Emergency surgical treatment of patients with Hunt-Hess grade V ruptured cerebral aneurysms can significantly improve the prognosis of some patients and have a better effect than conservative treatment.