颅内破裂动脉瘤的手术时机和预后的探讨
破裂,,动脉瘤;,早期手术;,晚期手术;,蛛网膜下腔出血;,手术时机,1资料和方法,2结果,3讨论,参考文献:
摘要： 目的: 探讨颅内破裂动脉瘤手术时机与临床预后的关系。方法: 回顾性分析105例破裂动脉瘤病例资料，每例患者入院时进行Hunt＆Hess分级，根据手术时间分为早期手术组33例(蛛网膜下腔出血3 d内手术)和晚期手术组72例(蛛网膜下腔出血3 d后手术)，出院时给予Glasgow预后评分，分析不同手术时机对预后的影响。结果： (1)早期手术组：1例Hunt＆HessⅠ级的双侧后交通动脉瘤患者于手术夹闭一侧动脉瘤后6 d死于对侧动脉瘤破裂出血，1例Hunt＆Hess Ⅲ级的患者入院当天死于原发性出血,31例预后良好以上，总死亡率为6.1%，手术死亡率0%，再出血率0%，术后CT复查均无脑梗塞。(2)晚期手术组：3例患者在待手术期间因再出血死亡，2例Hunt＆HessⅢ~Ⅳ级的患者于入院当天死于原发性蛛网膜下腔出血，总死亡率为6.9%，手术死亡率0%，再出血率4.2%，2例患者术后CT复查显示有脑梗塞。早期和晚期手术组比较，Hunt＆Hess分级Ⅰ~Ⅱ级患者的预后差异无统计学意义(P>0.05)，Hunt＆Hess分级Ⅲ~Ⅳ级的患者预后差异无统计学意义(P>0.05)，总死亡率差异无统计学意义(P>0.05)。结论： 早期手术组再出血率及脑缺血发生率明显少于晚期手术组，因此倾向于对分级较低的患者行早期手术。关键词： 动脉瘤; 早期手术; 晚期手术; 蛛网膜下腔出血; 手术时机
A clinical study of the relationship of timing to outcome of surgery forruptured cerebral aneurysms
DONG Jun，BAO Yu hai
(Department of Neurosurgery, First Affiliated Hospital, Xinjiang Medical University, Urumqi 830054, China)
Abstract: Objective: To investigate the relationship between the timing of surgery for intracranial ruptured aneurysms and the clinical outcome. Methods: A retrospective analysis of 105 patients with ruptured cerebral aneurysms undergoing treatment was made. Each patient's clinical grade according to Hunt＆Hess classification was assessed at admission. Early surgery was performed on 33 patients and delayed surgery on 72 patients. Evaluation was made by Glasgow outcome scale at the discharge. Result: Two patients were died in the early group. One patient with multiply aneurysms died of rebleeding on 6th day after operation, the other one died of initial hemorrhage. 31 patients had excellent or good outcomes in early group ......
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