Hunt-Hess I~IV级脑动脉瘤破裂出血实施显微镜手术夹闭瘤颈的最佳手术时机
| 作者: |
1刘成业,
1周奋,
1何安邦,
1李钢
1 三亚中心医院神经外科，海南 三亚 572000 |
| 通讯: |
李钢
Email: 275106746@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2020.06.015 |
摘要
目的：探讨Hunt-Hess I~IV级脑动脉瘤破裂出血患者实施显微镜手术夹闭瘤颈的最佳手术时机。方法：前瞻性选取2016年1月至2019年3月期间在三亚市中心医院神经外科诊治的120例脑动脉瘤破裂出血患者，Hunt-Hess分级I~IV级。患者均接受显微镜手术夹闭瘤颈治疗，患者和/或家属知晓本研究潜在风险和收益后，签署研究知情同意书。将65例脑动脉瘤破裂出血72 h内接受手术者设为A组，将55例脑动脉瘤破裂出血72 h后接受手术者设为B组。两组围手术期护理均相同，采用格拉斯哥预后评分(Clasgow outcome score，GOS)评估两组及不同Hunt-Hess分级患者的手术疗效，术后均随访6个月统计并发症发生情况。结果：两组病死率比较差异无统计学意义(χ2=0.007，P>0.05)；A组恢复良好率83.08%高于B组65.45%，差异有统计学意义(χ2=4.934，P<0.05)；A组Hunt-Hess分级I~II级恢复良好率(88.24%)略高于B组(82.14%)，差异无统计学意义(χ2=1.843，P>0.05)；但A组Hunt-Hess分级III~IV级恢复良好率(80.65%)明显高于B组(55.56%)，差异有统计学意义(χ2=4.244，P<0.05)。两组术后均出现动脉瘤再破裂、脑积水和脑血管痉挛等并发症，其中A组Hunt-Hess分级I~II级，III~IV级总并发症率分别为5.88%，6.45%，与B组14.29%，22.22%比较，差异无统计学意义(χ2=0.010，1.838，P>0.05)，A组总并发症率(6.15%)低于B组(18.18%)，差异有统计学意义(χ2=4.376，P<0.05)。结论：Hunt-Hess I~IV级脑动脉瘤破裂出血患者在早期(出血≤72 h)接受显微镜手术夹闭瘤颈治疗，能有效降低并发症率和改善预后，尤其以Hunt-Hess III~IV级患者获益显著。
关键词：
脑动脉瘤破裂出血；显微镜手术夹闭瘤颈；格拉斯哥预后评分；并发症
Best operation opportunity of microsurgery to clamp the neck of ruptured aneurysm in hunt Hess grade I–IV
CorrespondingAuthor: LI Gang Email: 275106746@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.06.015
Abstract
Objective: To explore the best opportunity for microsurgery to clamp the aneurysm neck in patients with hunt Hess grade I–IV cerebral aneurysm rupture and hemorrhage. Methods: A total of 120 patients with Hunt Hess grade I to IV ruptured cerebral aneurysms from January 2016 to March 2019 in Department of Neurosurgery of Sanya Central Hospital were selected prospectively. The patients were all treated with microsurgical clipping of the aneurysms neck. After the patients and/or their families knew the potential risks and benefits of this study, they signed the informed consent. Sixty-five patients with ruptured cerebral aneurysms and bleeding within 72 hours were recorded as group A, and 55 patients with ruptured cerebral aneurysms and bleeding 72 hours later were recorded as group B. The perioperative nursing of the two groups were the same. Glasgow prognosis (GOS) score was used to evaluate the surgical efficacy of the two groups and different Hunt Hess grade patients. The complications were followed up for 6 months. Results: There was no significant difference in mortality between the two groups (χ2=0.007, P>0.05). The recovery rate of group A was 83.08% higher than that of group B (65.45%) (χ2=4.934, P<0.05). The good recovery rate of hunt Hess grade I–II in group A was 88.24%, slightly higher than 82.14% in group B (χ2=1.843, P>0.05), but the good recovery rate of hunt Hess grade III–IV in group A was 80.65%, which was significantly higher than that in group B (χ2=4.244, P<0.05). There were complications such as aneurysm rupture, hydrocephalus and cerebral vasospasm in both groups. The total complications of hunt Hess I–II and III–IV in group A were 5.88% and 6.45%, respectively. There was no significant difference compared with 14.29% and 22.22% in group B (χ2=0.010, 1.838, P>0.05). The total complication rate in group A was 6.15% lower than that in group B (χ2=4.376, P<0.05). Conclusion: In the early stage (bleeding ≤72 hours), the patients with ruptured and bleeding of hunt Hess grade I–IV cerebral aneurysm received microsurgery to clamp the tumor neck, which can effectively reduce the complication rate and improve the prognosis, especially in hunt Hess grade III–IV patients.
Keywords：
cerebral aneurysm rupture and hemorrhage; microsurgical clipping of aneurysm neck; Glasgow prognosis score; complications