摘要
目的探讨高分级动脉瘤性蛛网膜下腔出血病人采用颅内动脉瘤介入栓塞术和颅内夹闭术治疗的临床疗效。方法高分级动脉瘤性蛛网膜下腔出血病人100例,根据手术方法的不同分成两组,观察组67例,行介入栓塞术,对照组33例,行颅内夹闭术。比较两组临床疗效,统计两组病人手术前、手术后1天、术后5天免疫球蛋白变化,记录病人住院时间和术后并发症发生情况。结果观察组预后良好率为70.15%,对照组为42.42%(P<0.05);观察组术后1天的lg G、lg M、lg A水平分别为(9.15±4.20)g/L、(1.15±4.20)g/L和(2.03±0.37)g/L,与术前比较显著降低(P<0.05),但高于对照组的(7.74±4.28)g/L、(0.86±0.25)g/L和(1.57±0.39)g/L(P<0.05),观察组术后5天的lg G、lg M、lg A水平分别为(10.98±5.67)g/L、(1.67±0.53)g/L和(2.45±0.44)g/L,与手术前相当(P>0.05),但高于对照组的(8.13±4.37)g/L、(1.13±0.52)g/L和(1.89±0.38)g/L(P<0.05);观察组住院时间为(19.52±6.92)天,显著短于对照组的(25.73±6.91)天(P<0.05);观察组术后颅内感染和脑血管痉挛发生率分别为1.49%、5.97%,低于对照组的9.09%和21.21%(P<0.05),观察组脑积水和再出血发生率均为1.49%,对照组均为3.03%,差异无统计学意义(P>0.05),两组病人在手术及随访期间均无死亡病例。结论血管栓塞介入治疗高分级动脉瘤性蛛网膜下腔出血效果较颅内夹闭术效果好,可减少对病人免疫功能的影响,缩短住院时间,降低术后并发症发生率。
Objective To investigate the clinical efficacy of intracranial aneurysm interventional embolization and intracranial clipping for patients with high grade aneurysmal subarachnoid hemorrhage.Methods 100 patients with high-grade aneurysmal subarachnoid hemorrhage were divided into groups according to the different surgical methods：67 patients undergoing embolization were included in the observation group,intracranial clipping of 33 cases were included in the control group. Compare the clinical efficacy of the two groups,The changes of immunoglobulin before operation,1 day after operation and 5 days after operation were recorded. The hospitalization time and postoperative complications were recorded. Results The good prognosis of the observation group was 70. 15%,which was significantly higher than that of the control group（42. 42%）（ P〈0. 05）. The levels of lg G,lg M and lg A of 1 day after operation in observation group were（9. 15 ± 4. 20） g/L,（1. 15 ± 4. 20） g/L and（2. 03 ± 0. 37） g/L,respectively,significantly lower than before surgery（ P〈0. 05） and which were significantly higher than control group[（7. 74 ± 4. 28） g/L,（0. 86 ± 0. 25） g/L and（ 1. 57 ± 0. 39） g/L]（ P〈0. 05）. Levels of lg G,lg M and lg A of 5 days after operation in the observation group were（10. 98 ± 5. 67） g/L,（1. 67 ± 0. 53） g/L and（2. 45 ± 0. 44） g/L,respectively,the same as before surgery（ P〈0. 05）. While,which were significantly higher than the control group[（8. 13 ± 4. 37） g/L,（1. 13 ± 0. 52） g/L and（1. 89 ± 0. 38） g/L,respectively]（ P〈0. 05）. Length of stay in the observation group was（19. 52 ± 6. 92） d,which was significantly shorter than that in the control group[（25. 73 ± 6. 91） d]（ P〈0. 05）. The incidences of postoperative intracranial infection and cerebral vasospasm were 1. 49% and 5. 97% in the observation group,whichwere significantly lower than those in the control group（9. 09% and 21. 21%）（ P〈0. 05）,incidences of hydrocephalus and rebleeding were 1. 49% in the observation group and 3. 03% in the control group,with no significant difference（ P〈0. 05）. No deaths were observed in both groups during surgery and followup. Conclusion Vascular embolization interventional treatment of high-grade aneurysm subarachnoid hemorrhage than intracranial clamping effect is good,can significantly reduce the impact of immune function in patients with shortened hospital stay and reduce the incidence of postoperative complications,safer.
作者
李爱国
刘之彝
龙晓东
杨露曦
徐宏
LI Aiguo;LIU Zhiyu;LONG Xiaodong(Department of Neurosurgery,Deyang People＇s Hospital,Deyang 618000,China)
出处
《临床外科杂志》
2018年第7期497-500,共4页
Journal of Clinical Surgery
关键词
颅内动脉瘤介入栓塞术
高分级动脉瘤性蛛网膜下腔出血
颅内夹闭术
预后
intracranial aneurysm interventional embolization
high grade aneurysmal sub-arachnoid hemorrhage
intracranial occlusion
short-term prognosis
