Hunt―Hess分级ⅢⅣ级动脉瘤性蛛网膜下腔出血早期手术临床研究.docVIP

Hunt―Hess分级ⅢⅣ级动脉瘤性蛛网膜下腔出血早期手术临床研究 　　[摘要]目的 总结Hunt-Hess分级Ⅲ、Ⅳ级动脉瘤性蛛网膜下腔出血的早期手术的临床经验。方法 选取本院2008年1月～2013年12月收治的Hunt-Hess分级Ⅲ、Ⅳ级动脉瘤性蛛网膜下腔出血患者60例，均经3D-CTA检查确诊，其中早期手术（72 h）39例，延期手术（3～10 d）21例，观察患者的临床疗效，分析早期手术和延期手术对患者治疗效果的影响。结果 早期手术组预后情况优于延期手术组（P0.05），未发生术后再次出血，死亡5例。结论 在Hunt-Hess分级Ⅲ、Ⅳ级动脉瘤性蛛网膜下腔出血患者的治疗中，早期手术患者的预后明显优于延期手术。 　　[关键词]Hunt-Hess分级；动脉瘤；蛛网膜下腔出血；早期手术；延期手术 　　[中图分类号] R743.35 [文献标识码] A [文章编号] 1674-4721（2017）02（a）-0061-03 　　[Abstract]Objective To summarize the clinical experience of early surgical treatment of aneurysmal subarachnoid hemorrhage with Hunt-Hess grade Ⅲ and Ⅳ.Methods 60 patients with aneurysmal subarachnoid hemorrhage with Hunt-Hess grade Ⅲ and Ⅳ admitted in our hospital from January 2008 to December 2013 were selected.They were all confirmed by 3D-CTA examination including 39 cases of early surgery （72 h），and 21 cases of delayed surgery （3～10 d）.The clinical curative effect of the patients was observed，and the effect of early surgery and delayed surgery on the therapeutic efficacy were analyzed.Results The situation of early surgical prognosis group was better than that of delayed surgery group（P 0.05）.No recurrence of postoperative bleeding was observed，and 5 cases were died.Conclusion In the treatment for the patients with aneurysmal subarachnoid hemorrhage with Hunt-Hess grade Ⅲ and Ⅳ，the prognosis of the patients receiving early surgery is significantly better than that of delayed operation. 　　[Key words]Hunt-Hess grade；Aneurysm；Subarachnoid hemorrhage；Early surgery；Delayed surgery 　　在神经外科临床上，蛛网膜下腔出血（subarachnoid hemorrhage，SAH）是动脉瘤的严重并发症之一，其主要由动脉瘤破裂引起[1]。一旦发生动脉瘤性SAH，极有可能发生再次出血，患者的死亡率明显增高[2]，是危害人类健康既常见又严重的疾病，也是神经外科最常见的脑血管疾病[3-4]。近年来，神经外科医疗技术的提高以及显微诊疗器械的广泛应用使颅内动脉瘤破裂的手术成功率大为提高[5-6]。但是国内外医学界关于颅内动脉瘤破裂导致SAH的手术时机选择仍然存在较为严重的分歧[7]。本研究回顾性分析了60例Hunt-Hess分级Ⅲ、Ⅳ级动脉瘤性SAH患者的临床资料，分析手术时机、手术方式对患者治疗效果的影响，现报道如下。 　　1资料与方法 　　1.1一般资料 　　选取本院2008年1月～2013年12月收治的Hunt-Hess分级Ⅲ、Ⅳ级动脉瘤性SAH患者60例，男性33例，女性27例；年龄29～74岁，平均（47.8±2.6）岁；Hunt-Hess分级：Ⅲ级26例，Ⅳ级34例；动脉瘤部位：颈内动脉33例，后交通动脉14例