超早期血管内栓塞治疗颅内动脉瘤破裂.docVIP

超早期血管内栓塞治疗颅内动脉瘤破裂　　作者：刘佩军，刘潺潺，周宏斌，何小明，常丽英，李文春 作者单位：1华中科技大学同济医学院附属襄樊医院神经内科，湖北 襄樊 441021;2郧阳医学院人体解剖学教研室，湖北 十堰 442000 　　【摘要】目的：探讨颅内动脉瘤破裂超早期血管内介入治疗的临床效果。方法：23 例不同部位颅内动脉瘤(26个) 患者，术前Hunt-Hess分级：Ⅰ～Ⅱ级12 例，Ⅲ级8例，Ⅳ级2例，Ⅴ级1例。在动脉瘤破裂48 h内气管内插管全麻下行电解式可脱性微弹簧圈(GDC)栓塞治疗。结果：术后随访6～24月，恢复良好者20例(86.95%);出现偏瘫和单纯运动性失语各1例(4.35%)，后经综合治疗1个月后逐渐恢复;死亡1例(4.35%)(Hunt-Hess Ⅴ级)。无再出血病例发生。结论：超早期电解式可脱性微弹簧圈栓塞治疗可避免动脉瘤再次破裂出血，减少脑血管痉挛，降低死亡率。 　　【关键词】 颅内动脉瘤;破裂;栓塞 　　Endovascular Embolization Treatment of Ruptured Intracranial Aneurysms in Super-early Stage 　　LIU Pei - jun, LIU Chan - chan, ZHOU Hong - bin, HE Xiao - ming, CHANG Li - yin, LI Wen - chun 　　(1Department of Neurology, Xiangfan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Xiangfan, Hubei 441021; 2Department of Anatomy, Yunyang Medical College, Shiyan , Hubei 442000, China) 　　Abstract: Objective To observe the efficacy of guglielmi detachable coil (GDC) used for embolism of ruptured aneurysm as emergent treatment in super-early stage. Methods Twenty-three cases suffered from intracranial aneurysms were treated by GDC within 48 hours. Preoperative Hunt-Hess grade: 12 cases were Ⅰ～ Ⅱ, 8 cases were Ⅲ, 2 cases were Ⅳand 1 case was Ⅴ. Results After follow-up from 6 to 24 months after operation, 20 cases(86.95%)recovered excellently. Hemiplegia and anepia was found only in 1 case(4.35%)and Brocas aphasia 1 case(4.35%)after operation. But the two patients gradually recovered 1 month later. One case(4.35%)died because the Hunt-Hess was Ⅴgrade. No rebleeding occurred. Conclusion The treatment for the patients from SAH Ⅰ～ Ⅳ grade in super-early stage could avoid rebleeding from aneurysms , decrease the incidence of vasospasm and mortality. 　　Key words：Intracranial aneurysm; Rupture; Embolization 颅内动脉 　　瘤是脑血管疾病患者发生自发性蛛网膜下腔出血(Subayachnoid hemoyyhage, SAH)和/或脑出血的主要原因之一。“超早期”介入手术治疗是指在动脉瘤破裂导致SAH和/或脑内血肿后48 h内进行。颅内动脉瘤的传统治疗手段为瘤颈夹闭术，血管内栓塞治疗是新兴的微创、高效的治疗方法。我院自2005年以来对23例颅内动脉瘤破裂患者采用超早期血管内栓塞治疗，疗效满意，报道如下。 　　1 资料和方法 　　1.1 一般资料 　　2005年1月-200