早期手术治疗合并急性神经源性肺水肿的破裂颅内动脉瘤

Clinical effect of early surgical treatment for ruptured intracranial aneurysms with acute neurogenic pulmonary edema

摘要:

目的 探讨早期手术治疗合并急性神经源性肺水肿的破裂颅内动脉瘤的疗效。方法 回顾性分析26例合并急性神经源性肺水肿的破裂颅内动脉瘤患者的临床资料，早期手术组15例，保守治疗组11例，分析两组患者生存率和动脉瘤再破裂率，以及入院即刻和24小时的动脉血乳酸和氧合指数（PaO₂/FIO₂）变化。结果 ①早期手术组患者生存率明显高于保守治疗组（73.3% vs.18.2%，P<0.05），动脉瘤再破裂率低于保守治疗组（6.7% vs.81.8%，P<0.05）；②早期手术组动脉血乳酸值24小时后明显低于入院即刻，也低于保守治疗组（P<0.05）；③早期手术组患者动脉血PaO₂/FIO₂ 24小时后高于入院即刻值，也高于保守治疗组，差异有统计学意义（P<0.05）。结论 积极早期手术治疗能明显降低颅内动脉瘤的再破裂率，并降低动脉血乳酸，改善氧合指数，提高合并急性神经源性肺水肿的破裂颅内动脉瘤患者的生存率。

Abstract:

Objective To investigate the clinical effect of early surgical treatment for ruptured intracranial aneurysms with acute neurogenic pulmonary edema.Methods A retrospective analysis was performed for the clinical data of 26 patients with ruptured intracranial aneurysms and acute neurogenic pulmonary edema, and among these patients, 15 underwent early surgical treatment (early surgery group) and 11 underwent conservative treatment (conservative treatment group). The two groups were analyzed in terms of survival rate, re-rupture rate of aneurysms, and arterial blood lactate and oxygenation index (PaO₂/FIO₂) immediately and at 24 hours after admission.Results Compared with the conservative treatment group, the early surgery group had a significantly higher survival rate (73.3% vs 18.2%, P<0.05) and a significantly lower re-rupture rate of aneurysms (6.7% vs 81.8%, P<0.05). The early surgery group had a significant reduction in arterial blood lactate and a significantly lower level of arterial blood lactate than the conservative treatment group at 24 hours after admission (P<0.05). The early surgery group had a significant increase in PaO₂/FIO₂ at 24 hours after admission, as well as a significantly higher PaO₂/FIO₂ than the conservative treatment group (P<0.05).Conclusions Early surgical treatment can significantly reduce the re-rupture rate of intracranial aneurysms and the level of arterial blood lactate, increase oxygenation index, and improve the survival rate of patients with ruptured intracranial aneurysms and acute neurogenic pulmonary edema.