高分级动脉瘤性蛛网膜下腔出血的早期手术治疗

Early surgical treatment for poor-grade aneurysmal subarachnoid hemorrhage

摘要:

目的探讨高分级动脉瘤性蛛网膜下腔出血的临床特点及早期手术治疗效果。方法回顾性分析36 例Hunt-Hess 分级Ⅳ、Ⅴ级动脉瘤性蛛网膜下腔出血患者的临床资料。其中，Ⅳ级28 例，Ⅴ级8 例；显微手术夹闭28 例，介入治疗8 例。采用出院时格拉斯哥预后评分（GOS）评价患者的预后。结果2 例患者术后出现脑积水并行脑室腹腔分流术，3 例出现肺部感染。Hunt-Hess分级Ⅳ级患者预后良好21 例，预后不良7 例，Ⅴ级患者预后良好3 例，预后不良5 例，预后良好比分别为75%（21/28）、37.5%（3/8），两组预后比较差异有统计学意义（P <0.05）；显微手术夹闭治疗的患者预后良好18 例，预后不良10 例，死亡3 例；介入治疗的患者预后良好6例，预后不良2 例，预后良好比分别为64.29%（18/28）、75%（6/8），两者比较预后差异无统计学意义（P >0.05）。结论Hunt-Hess分级Ⅳ级的患者应根据患者综合情况选择合适的手术方式争取早期手术治疗，Ⅴ级患者早期手术治疗效果尚有待进一步研究。

Abstract:

Objective To investigate the clinical efficacy of the early surgical treatment of poor-grade aneurysmal subarachnoid hemorrhage and its clinical features. Methods The clinical data of 36 patients (Hunt-Hess grade Ⅳor Ⅴ) with aneurysmal subarachnoid hemorrhage were analysed retrospectively. There were 28 patients with Hunt-Hess grade Ⅳand 8 patients with Hunt-Hess grade Ⅴ. There were 28 patients with microsurgical clipping and 8 patients with interventional embolization. The therapeutic effect was evaluated by Glasgow Outcome Score (GOS). Results There were 2 patients that underwent V-P shunt because of hydrocephalus and 3 patients with pulmonary infection. Of the patients with Hunt-Hess grade Ⅳ, 21 had good prognosis, 7 had poor prognosis, and of the patients with Hunt-Hess grade Ⅴ, 3 had good prognosis, 5 had poor prognosis. The rates of good prognosis were 75% (21/28) and 37.5% (3/8), respectively. The difference of the prognosis between the two groups was statistically significant (P < 0.05). Of the patients with microsurgical clipping, 18 had good prognosis, 10 had poor prognosis, 3 were dead. And of the patients with interventional embolization, 6 had good prognosis, 2 had poor prognosis. The rates of good prognosis were 64.29% (18/28) and 75% (6/8), respectively. The difference of the prognosis between the two groups was not statistically significant (P > 0.05). Conclusions For the patients with Hunt-Hess grade Ⅳ, the early proper surgical treatment should be performed according to the conditions of them. The effectiveness of early surgical treatment remains to be further studied for the patients with Hunt-Hess grade Ⅴ.