摘要
目的 探讨185例破裂脑动脉瘤采用急诊或早期综合救治措施的效果.方法 所有患者均急诊行头颅CT确诊为蛛网膜下腔出血（SAH）,应用相关的措施和药物改善和纠正病人生命体征、高颅压、高血压、低氧血症等,尽早行数字减影血管造影（DSA）,均确诊为颅内动脉瘤,急诊或72h内行显微外科夹闭126例,介入栓塞59例.术中、术后积极采取各种措施防治脑血管痉挛、脑水肿、胃肠道出血等并发症.结果 185例不同程度病情的患者预后良好131例,总预后良好率为71%.其中开颅显微手术夹闭126例,预后良好87例,良好率为69%,轻残15例,重残9例,植物状态6例,死亡9例（7.2%）;介入栓塞59例,预后良好44例,良好率为74.5%,轻残7例,重残4例,植物状态1例,死亡3例（5.1%）.两组预后良好率比较,无显著性差异（P〉0.05）.致残率、死亡率均无显著性差异.结论 尽早明确诊断,加强围手术期救治管理,急诊或早期根据患者实际情况行开颅手术夹闭或介入栓塞,消除动脉瘤再出血破裂危险,利用早期综合救治措施可降低死亡率、改善预后.
Objective To explore the effect of 185 cases of ruptured aneurysms by the way of the earliest comprehensive rescue.Methods All patients were diagnosed as SAH caused aneurysm rupture by CT scan. All cases were given management and drugs with consistence on their symptoms such as abnormal life signs,hypertension,high intracranial pressure,hyoxemia ere.All cases were examined with DSA as early as possible and diagnosed as aneurysm rupture. 126 cases were treated with surgical clipping and 59 were treated with endovascular embolization within 3 days or emergence.All sorts of measures and drugs were given exactly to treat with complications such as cerebral vasospasm,cerebral edema, stomach-gastral bleeding etc during operation and post-operation.Results Good recovery cases were 131 out of 185 and good recovery rate was 71%.The outcome of 126 cases with surgical clipping was good recovery 87 cases and good recovery rate 69%,moderate disability 15 cases,severe disability 9 cases,persistent vegetative state 6 cases,death 9 cases and mortality 7.2%.The outcome of 59 cases with endovascular embolization was good recovery 44 cases and good recovery rate 74.5%,moderate disability 7 cases,severe disability 4 cases,persistent vegetative state 1 case,death 3 cases and mortality 5.1%.Two groups in good recovery rate,mortality, and disability rate has no significant difference.Conclusion According to patients＇ actuate cases,suitable therapy measure as surgical clipping or endovascular embolization were selected and etiology diagnose was clarified as fast as possible.Early eliminating aneurysms was important to prevent rebleeding and decrease mortality and disability rates.The earliest comprehensive rescue can prevent complications,further decrease mortality and improve prognosis.
出处
《中国血液流变学杂志》
CAS
2011年第1期43-46,共4页
Chinese Journal of Hemorheology
