夹闭和栓塞治疗颅内动脉瘤对蛛网膜下腔出血脑-第三军医大学学报.doc

PAGE 夹闭和栓塞治疗颅内动脉瘤对蛛网膜下腔出血脑血管痉挛的影响 张晓冬，吴海涛，孙晓川，朱继，唐文渊 （重庆医科大学附属第一医院神经外科，重庆400016） [摘要]：目的 研究两种治疗方法对颅内动脉瘤性蛛网膜下腔出血所致脑血管痉挛的影响因素。方法 对123例颅内动脉瘤患者进行回顾性研究。所有病例分为两组，显微瘤颈夹闭组90例，血管内栓塞组33例。使用多元逻辑回归，对治疗方式、性别、年龄、发病至入院时间、动脉瘤尺寸、部位、数量、Hunt分级、监护时间、住院时间进行统计学研究，明确其对脑血管痉挛、症状性脑血管痉挛的影响，找出影响脑血管痉挛的危险因子。结果 在动脉瘤显微手术夹闭组中，100%的病例发生了脑血管痉挛，75.6%的病例发生了症状性脑血管痉挛；在血管内栓塞组中，84.8%的病例发生了脑血管痉挛，45.5%发生了症状性脑血管痉挛。结论：和显微瘤颈夹闭术比较，血管内栓塞治疗术所致脑血管痉挛程度较轻，症状性脑血管痉挛的发生率也降低。脑血管痉挛程度的独立预测因子是年龄较大，小动脉瘤，发病至入院时间短、Fisher 分级3 、4级，Hunt和HessⅢ、Ⅳ级；症状性脑血管痉挛的独立预测因子是动脉瘤位于后循环，Hunt和HessⅡ、Ⅲ、Ⅳ级。 [关键词]：颅内动脉瘤；瘤颈夹闭术；栓塞；血管痉挛；蛛网膜下腔出血 [中图分类号]：R651.1+2; R743.35 The effect of clipping and coiling on the incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage ZHANG Xiao-dong, WU Hai-tao, SUN Xiao-chuan, ZHU Ji, TANG Wen-yuan (Department of Neurosurgery, First affiliated hospital, Chongqing Medical University, Chongqing 400016, China ) [Abstract] Objective To explore the influence of different treatment modalities (clipping/coiling) on the incidence of vasospasm in aneurysmal subarachnoid hemorrhage patients. Methods One hundred twenty-three consecutive patients were nonrandomly assigned to either surgical (n=90) or endovascular (n=33) treatment group. The following parameters were prospectively collected in a data base and retrospectively analyzed for association with two outcome measures degree of vasospasm and symptomatic vasospasm: 1) Hunt and Hess grade, 2) Fisher grade, 3) Aneurysm quantity and location, 4) Aneurysm treatment modality, 5) Admit day, 6) NICU stay length and 7) Hospital stay length. Cerebral vasospasm and symptomatic cerebral vasospasm were analysed and compared retrospectively of clipped and coiled patients with ruptured aneurysms, and multivariate regression analyses was performed to assess the risk for the two outcome measures. Results In the clipping group there was 100% vasospam and 75.6% symptomatic vasospasm; in the coiling group there was 84.8% vasospasm and 45.5% symptomatic vasospasm. Con