颅内动脉瘤破裂合并脑内血肿的早期手术治疗.docxVIP

颅内动脉瘤破裂合并脑内血肿的早期手术治疗 　　【摘要】目的：探讨颅内动脉瘤破裂合并脑内血肿的早期手术治疗效果。方法：回顾性分析30例颅内动脉瘤破裂合并脑内血肿患者的临床资料，探讨早期显微外科手术夹闭动脉瘤并清除脑内血肿的临床效果和预后。术后当天复查颅脑ct，术后第1天复查cta，术后3个月进行格拉斯哥预后评分（glasgowoutcomescale，gos）评估预后，并进行定期随访。结果：30例患者共检查出32个动脉瘤，均成功夹闭动脉瘤的同时进行了血肿清除术，术后cta复查未见动脉瘤瘤颈残留。术后发生肺部感染11例，颅内感染1例，脑积水3例，电解质紊乱6例，肢体偏瘫8例，应激性溃疡5例，癫痫1例。术后3个月，gos5分21例，gos4分6例，gos3分2例，gos2分1例，gos1分0例;规律随访，患者未再自发颅内蛛网膜下腔出血及动脉瘤复发。结论：颅内动脉瘤破裂合并脑内血肿，早期显微镜下夹闭动脉瘤的同时清除脑内血肿，患者预后较好。 　　【关键词】显微外科手术脑内血肿颅内动脉瘤 　　doi：10.14033/j.cnki.cfmr.2019.29.022文献标识码b文章编号1674-6805（2019）29-00-03 　　[abstract]objective：toinvestigatetheeffectofearlysurgicaltreatmentofintracranialaneurysmrupturecombinedwithintracerebralhematoma.method：theclinicaldataof30patientswithintracranialaneurysmrupturecombinedwithintracerebralhematomawereretrospectivelyanalyzed.theclinicaleffectandprognosisofearlymicrosurgeryforclippinganeurysmandclearingintracerebralhematomawerediscussed.cranialctwasreviewedonthedayaftersurgery，andctawasreviewedonthefirstdayafterthesurgery.theglasgowoutcomescale（gos）wasusedtoassesstheprognosis3monthsafterthesurgery，andregularfollow-upwasconducted.result：thirty-twoaneurysmsweredetectedin30patients.alltheaneurysmsweresuccessfullyclippedandthehematomawasremoved.postoperativectareexaminationshowednoresidualaneurysmneck.therewere11casesofpulmonaryinfection，1caseofintracranialinfection，3casesofhydrocephalus，6casesofelectrolytedisorder，8casesoflimbhemiplegia，5casesofstressulcerand1caseofepilepsy.threemonthsaftersurgery，gosin5pointswas21cases，gosin4pointswas6cases，gosin3pointswas2cases，gosin2pointswas1case，gosin1point0cases.regularfollow-up，nospontaneoussubarachnoidhemorrhageandaneurysmrecurrenceoccurred.conclusion：intracranialaneurysmrupturecombinedwithwasintracerebralhematoma，earlymicrosurgeryclippinganeurysmandclearanceofintracerebralhematoma，theprognosisofthepatientsisbetter. 　　[keywords]microsurgeryintracerebralhematomaintracranialaneurysm 　　first-author’saddress：nanpingfirsthospitalaffiliatedtofujianmedicaluniversity，nanping