动脉瘤夹闭术对不同Fisher分级患者蛛网膜下腔积血量及脑血管痉挛程度影响.docVIP

动脉瘤夹闭术对不同Fisher分级患者蛛网膜下腔积血量及脑血管痉挛程度影响 　　【摘要】 目的：探讨动脉瘤夹闭术对不同Fisher分级蛛网膜下腔出血（subarachnoid hemorrhage，SAH）患者蛛网膜下腔积血量及脑血管痉挛程度的影响。方法：选取2012年1月-2015年1月于本院就诊的180例SAH患者，其中Fisher分级Ⅰ级患者60例，Ⅱ级患者75例，Ⅲ级患者45例，将其分为动脉瘤性SAH组（A组，60例），非动脉瘤SAH组（B组，54例），同期未出现破裂动脉瘤行夹闭术的患者组（C组，66例），比较各组患者的手术效果。结果：治疗后，三组患者脑痉挛评分均有所下降，三组患者血流速度在第7天和第13天均明显升高，差异均有统计学意义（P0.05），而A、B组患者中I、Ⅱ级患者的血流速度均明显高于Ⅲ级患者血流速度，差异均有统计学意义（P0.05）。结论：行动脉瘤夹闭术会增加患者蛛网膜下腔出血量，Fisher分级I级和Ⅱ级患者的脑血管痉挛症状及出血较Ⅲ级患者更重，该治疗方法对Ⅲ级患者起到的效果更好。 　　【关键词】 动脉瘤夹闭术； 蛛网膜下腔积血； 脑血管痉挛； 动力学 　　中图分类号 R743.35 文献标识码 B 文章编号 1674-6805（2016）16-0146-02 　　【Abstract】 Objective：To investigate the influence of aneurysm clipping on subarachnoid product volume and the degree of cerebral vasospasm in patients with different Fisher grades.Method：A total of 180 of SAH patients in our hospital from January 2012 to January 2015，according to Fisher grade，including 60 cases of grade I，75 cases of grade Ⅱ and 45 cases of grade Ⅲ，they were selected and devided into the aneurysmal SAH group （group A，60 cases），non aneurysmal SAH group （group B，54 cases），and the group of patients undergoing aneurysm clipping surgery over the same period but did not appear the rupture of vein （group B，66 cases）.The operation effect of the three groups were compared.Result：After the treatment，the cerebral spasm scores decreased in all the 3 groups，the blood flow velocity of all the groups increased in the 7th and 13th day significantly，and which of the patients with I and Ⅱ Fisher grade in group A and group B were significantly higher than that of the patients with grade Ⅲ，the differences were statistically significant（P0.05）.Conclusion：The operation of aneurysm clipping will increase the intracranial hemorrhage of patients，but the cerebral vasospasm and intracranial hemorrhage of patients with I and Ⅱ Fisher grade are more serious than that of the grade Ⅲ，this therapy is more effective for the patients with grade Ⅲ. 　　【Key words】 Aneurysm clipping； Subarachnoid hemorrhage； Cerebral vasospasm； Kinetics