摘要
目的探讨高分级动脉瘤性蛛网膜下腔出血(aSAH)的手术疗效。方法回顾性分析2001—2008年复旦大学附属华山医院神经外科经手术治疗的27例(动脉瘤28个)Hunt-HessⅣ、Ⅴ级aSAH患者的临床资料。其中入院时Hunt-HessⅣ级23例,Ⅴ级4例。行动脉瘤夹闭27个,孤立和血管重建1个。术中行第三脑室造瘘或脑室外引流13例,去骨瓣减压14例。分析影响患者预后的因素。结果①27例中,出院时死亡8例,死亡原因为术中出血导致术后脑梗死2例;术后严重的血管痉挛导致大面积脑梗死6例。出院时残留偏侧肢体肌力下降6例,定向障碍5例,意识不清4例。②术后出现肺部感染19例,电解质紊乱20例,心律失常6例。③平均随访47个月(15～96个月)。随访期死亡2例。总体疗效恢复良好率为51.9%(14/27),预后差为11.1%(3/27),病死率为37.0%(10/27)。⑤在年龄、Hunt-Hess分级、术前格拉斯哥昏迷评分、手术距离出血的时间及是否合并急性脑积水的因素中,影响患者的预后,且差异有统计学意义的为术前格拉斯哥昏迷评分。结论高级别aSAH患者预后与多因素有关。根据患者病情选择合理的治疗方式,可以改善高分级aSAH患者预后。
Objective To investigate the efficacy of microsurgery for treatment of high-grade aneu- rysmal subarachnoid hemorrhage （aSAH）. Methods The clinical data of 27 patients （ 28 aneurysms ; Hunt-Hess grade IV or V） with aSAH treated in the Department of Neurosurgery, Huashan Hospital, Fudan University, China from 2001 to 2008 were analyzed retrospectively. There were 23 patients with Hunt-Hess grade IV and 4 with Hunt-Hess grade V. A total of 27 aneurysms were clipped, and one was trapped and revascularized. Third ventriculostomy or external ventricular drainage was performed in 13 patients and decompressive craniectomy was performed in 14 patients during the operations. The clinical efficacy of the patients was observed. Results （1） Of the 27 patients, 8 were died after operation. The causes of death were intraoperative bleeding caused postoperative cerebral infarction （2 cases ） ; postoperative severe vasospasm caused massive cerebral infarction （6 cases ）. Six patients had residual unilateral limb muscle strength decline at discharge, 5 had disorientation, and 4 were unconsciousness. （2）Nineteen pa- tient had postoperative pulmonary infections, 20 had electrolyte disturbance, and 6 had arrhythmia. （3）The patents were followed up for 15 -96 months（ mean 47 months）. Two patents died during the follow-up period. The good recovery rate of general efficacy was 51.9% （14/27） , the poor prognosis rate was 11.1% （3/27）, and the mortality rate was 37. 0% （10/27）. （4）Different age, Hunt-Hess grade, preoperative Glasgow outcome scale （GOS） score, time from bleeding to operation, and with or without acute hydrocephalus were the factors, affecting the prognosis of patients. The preoperative GOS score was the only factor had statistically significant difference. Conclusion The prognosis of patients with high-grade aSAH was associated with multiple factors. Selecting proper treatment modality according to the conditions of patients may improve the prognosis of the patients with high-grade aSAH.
出处
《中国脑血管病杂志》
CAS
2010年第8期419-422,共4页
Chinese Journal of Cerebrovascular Diseases
基金
上海市卫生局青年基金资助项目(2009Y004)
