徐圣隆 叶指南 何金峰 徐浩

[摘要] 目的 探討Hunt-Hess Ⅳ～Ⅴ级颅内动脉瘤治疗时机的选择。 方法 选取2016年6月至2019年6月我院收治的60例颅内动脉瘤患者的临床病例资料进行回顾性分析。其中30例患者在12 h内完成手术（作为观察组），其余30例患者在12～24 h内完成手术（作为对照组）。评估两组患者出院时格拉斯哥昏迷评分（GCS）、格拉斯哥预后评分（GOS）、巴塞尔指数（BI），并记录患者术后并发症发生率。 结果 两组患者术前GCS评分、GOS评分、BI指数比较，差异无统计学意义（P>0.05），两组患者出院时GCS评分、GOS评分、BI指数比较，差异有统计学意义（P<0.05），且观察组患者出院时GCS评分、GOS评分、BI指数明显高于对照组（P<0.05）。观察组预后良好率明显高于对照组（90.00% vs. 76.67%）（χ2=4.800，P=0.028）。两组患者术后脑积水、脑血管痉挛、脑梗死、动脉瘤再破裂出血发生率比较，差异无统计学意义（P>0.05），而观察组下肢静脉栓塞发生率明显少于对照组（P<0.05）。采用二元Logistic回归分析结果显示，早期介入治疗可明显改善患者预后（OR=0.721，Wald χ2=5.125，95%CI=0.342～0.961，P<0.05）。 结论 对于Hunt-Hess Ⅳ～Ⅴ级颅内动脉瘤患者，早期手术介入治疗可有效改善患者预后，减少术后并发症的发生。

[关键词] Hunt-Hess Ⅳ～Ⅴ级颅内动脉瘤;介入治疗;术后并发症;预后

[中图分类号] R739.41          [文献标识码] B          [文章编号] 1673-9701（2021）35-0044-04

Timing of treatment for Hunt-Hess Ⅳ-Ⅴ intracranial aneurysm

XU Shenglong   YE Zhinan   HE Jinfeng   XU Hao

Department of Neurology， Taizhou Municipal Hospital in Zhejiang Province， Taizhou   318000， China

[Abstract] Objective To explore the timing of treatment for Hunt-Hess Ⅳ-Ⅴ intracranial aneurysm. Methods The clinical data of 60 patients with intracranial aneurysm treated in our hospital from June 2016 to June 2019 were analyzed retrospectively. Among them， 30 patients completed the operation within 12 hours（as the observation group）， and the remaining 30 patients completed the operation within 12-24 hours（as the control group）. The Grasse Coma Scale （GCS），Glasgow Outcome Scale （GOS） and Basel index （BI） were evaluated at discharge in two groups， and the incidence of postoperative complications was recorded. Results There were no significant differences in GCS score， GOS score and BI index between the two groups before operation（P>0.05）， but there were significant differences in GCS score， GOS score and BI index between the two groups when they were discharged from hospital（P<0.05），GCS score， GOS score and BI index in observation group were significantly higher than those in control group at discharge（P<0.05）. The rate of good prognosis in observation group was significantly higher than that in control group （90.00% vs. 76.67%） （χ2=4.800， P=0.028）. There were no significant differences in the incidence of hydrocephalus， cerebral vasospasm， cerebral infarction and aneurysm rupture between the two groups after operation（P>0.05）， but the incidence of venous embolism of lower limbs in the observation group was significantly less than that in the control group（P<0.05）. Binary Logistic regression analysis showed that early interventional therapy could significantly improve the prognosis of patients（OR=0.721， Wald χ2=5.125， 95%CI=0.342-0.961， P<0.05）. Conclusion For patients with Hunt-Hess Ⅳ-Ⅴ intracranial aneurysm， early surgical intervention can effectively improve the prognosis and reduce postoperative complications.

[Key words] Hunt-Hess Ⅳ-Ⅴ intracranial aneurysm; Interventional therapy; Postoperative complications; Prognosis

颅内动脉瘤是颅内动脉管壁异常隆起形成的血管性包块，包块破裂可导致颅内出血，严重威胁患者的生命[1]。对于颅内动脉瘤破裂，临床上以介入栓塞手术治疗为主。对于Hunt-Hess Ⅰ～Ⅲ级患者的早期介入治疗，目前已达成共识，但对Hunt-Hess Ⅳ～Ⅴ级患者，选择不同介入治疗时期对其疗效的影响仍存在较大争议[2]。有学者认为早期介入治疗可以减少血管痉挛、颅内动脉瘤再次破裂出血及术后并发症，但也有部分学者存在不同意见，认为延期介入治疗可以减少患者身体应激反应，利于预后恢复[3]。……