颅内动脉瘤介入栓塞术和颅内夹闭术治疗高分级动脉瘤性蛛网膜下腔出血的临床疗效观察
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摘要
目的探讨采取颅内动脉瘤介入栓塞术和颅内夹闭术治疗高分级动脉瘤性蛛网膜下腔出血(aneurismal subarachnoid hemorrhage,aSAH)的疗效及安全性。方法选取谷城县人民医院2016-05至2017-05接收的66例aSAH患者,随机分为对照组(n=33)与观察组(n=33)。观察组采用颅内动脉瘤介入栓塞术治疗,对照组采用颅内夹闭术治疗。比较两组患者的治疗疗效及免疫球蛋白M(immunoglobulin M,IgM)、免疫球蛋白G(immunoglobulin G,IgG)、免疫球蛋白A(immunoglobulin A,IgA)。结果观察组预后良好率为75.76%,较对照组高,且差异具有统计学意义(P<0.05);两组术后1 d各项免疫指标Ig M、Ig G、Ig A均较术前明显降低(P<0.05),但观察组较对照组高(P<0.05);观察组术后5 d的免疫指标均与术前相当(P>0.05),与对照组比较有明显差异(P<0.05);观察组住院时间为(19.52±5.41)d,对照组为(25.71±6.54)d,差异具有统计学意义(t=-4.189,P<0.001);观察组脑血管痉挛、颅内感染率较对照组低,且差异具有统计学意义(χ~2=8.875,P<0.05;χ~2=9.745,P<0.05)。结论高分级动脉瘤性蛛网膜下腔出血采取血管栓塞介入治疗,疗效好于颅内夹闭术,并发症少,值得推广。
Objective The objective of this study was to investigate the clinical efficacy and safety of intracranial aneurysm interventional embolization and intracranial clipping for patients with high grade aneurysmal subarachnoid hemorrhage(aSAH).Methods Sixty-six patients with aSAH treated in Gucheng County People's Hospital from May 2016 to May 2017 were randomly divided into control group(n=33) and observation group(n=33). The observation group was treated with embolization, and the control group with intracranial clipping. The clinical efficacy and IgM(immunoglobulin M), IgG(immunoglobulin G), and IgA(immunoglobulin A) were compared between the two groups. Results The good prognosis of the observation group was 75.76%, which was higher than that of the control group, and the difference was statistically significant(P<0.05). The levels of IgM, IgG and IgA of 1 d after the operation in the two groups were significantly lower than those before the operation(P<0.05), and the observation group was significantly higher than the control group(P<0.05). The immune levels of 5 d after the operation of the observation group was the same as before operation(P>0.05), which were significantly higher than the control group(P<0.05). The hospital stay was(19.52±5.41) d in the observation group, and the control group was(25.71±6.54) d. The difference was statistically significant(t=-4.189, P<0.001). The incidence of cerebral vasospasm and intracranial infection in the observation group were lower than those in the control group, and the difference was statistically significant(χ~2=8.875,P<0.05; χ~2=9.745, P<0.05). Conclusions The treatment efficacy of vascular embolization for aSAH is better than intracranial clipping. The complications are few and worth promoting.
Objective The objective of this study was to investigate the clinical efficacy and safety of intracranial aneurysm interventional embolization and intracranial clipping for patients with high grade aneurysmal subarachnoid hemorrhage(aSAH).Methods Sixty-six patients with aSAH treated in Gucheng County People's Hospital from May 2016 to May 2017 were randomly divided into control group(n=33) and observation group(n=33). The observation group was treated with embolization, and the control group with intracranial clipping. The clinical efficacy and IgM(immunoglobulin M), IgG(immunoglobulin G), and IgA(immunoglobulin A) were compared between the two groups. Results The good prognosis of the observation group was 75.76%, which was higher than that of the control group, and the difference was statistically significant(P<0.05). The levels of IgM, IgG and IgA of 1 d after the operation in the two groups were significantly lower than those before the operation(P<0.05), and the observation group was significantly higher than the control group(P<0.05). The immune levels of 5 d after the operation of the observation group was the same as before operation(P>0.05), which were significantly higher than the control group(P<0.05). The hospital stay was(19.52±5.41) d in the observation group, and the control group was(25.71±6.54) d. The difference was statistically significant(t=-4.189, P<0.001). The incidence of cerebral vasospasm and intracranial infection in the observation group were lower than those in the control group, and the difference was statistically significant(χ~2=8.875,P<0.05; χ~2=9.745, P<0.05). Conclusions The treatment efficacy of vascular embolization for aSAH is better than intracranial clipping. The complications are few and worth promoting.
引文
[1]李鑫,郭建华,朱彩琴,等.颅内动脉瘤介入栓塞术后的护理研究[J].山西医药杂志, 2016, 45(11):1353-1355. DOI:10.3969/j.issn.0253-9926.2016.011.046.
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[4]Liang, C W, Chen R, Macri E, et al. Preadmission beta-blockers are associated with decreased incidence of neurogenic stunned myocardium in aneurysmal subarachnoid hemorrhage[J]. J Stroke Cerebrovasc Dis,2013, 22(5):601-607. DOI:10.1016/j.jstrokecerebrovas dis.2011.10.006.
[5]赵经纬,罗旭颖,徐明,等.全面无反应量表在重症动脉瘤性蛛网膜下腔出血预后评估中的应用[J].首都医科大学学报, 2018, 39(1):28-34. DOI:10.3969/j.issn.1006-7795.2018.01.006.
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[7]陈平,苗壮,韩海玲,等.栓塞及夹闭治疗老年动脉瘤性蛛网膜下腔出血患者安全性及有效性的Meta分析[J].中国老年学杂志, 2018, 38(9):2057-2059.DOI:10.3969/j.issn.1005-9202.2018.09.004.
[8]胡新永,来海鸥,姬利,等.夹闭及栓塞治疗颅内动脉瘤对蛛网膜下腔出血患者脑血管痉挛及神经功能的[1][2][3][4][5][6][7][8]影响[J].广西医科大学学报, 2017, 34(1):100-102.DOI:10.16190/j.cnki.45-1211/r.2017.01.026.
[9]何士科.介入栓塞术与颅内夹闭术治疗高分级动脉瘤性蛛网膜下腔出血的临床分析[J].中华全科医学,2017,15(6):974-976. DOI:10.16766/j.cnki.issn.1674-4152.2017.06.020.
[10] Lin N, Zenonos G, Kim A H, et al. Angiogram-negative subarachnoid hemorrhage:relationship between bleeding pattern and clinical outcome[J]. Neurocrit Care, 2012,16(3):389-398. DOI:10.1007/s12028-012-9680-6.
[11]李刚,曹芳,焦松,等.弹簧圈瘤腔内栓塞与动脉瘤颈夹闭术治疗高分级动脉瘤性蛛网膜下腔出血的效果对比[J].中国老年学杂志,2017,37(22):5587.5589. DOI:10.3969/j.issn.1005-9202.2017.22.044.
[12] Ishihara H, Kunitsugu I, Nomura S, et al. Seasonal variation in the incidence of aneurysmal subarachnoid hemorrhage associated with age and gender:20-year results from the yamaguchi cerebral aneurysm registry[J]. Neuroepidemiology, 2013, 41(1):7-12. DOI:10.1159/000345247.
[13]李俊君,路华.不同介入栓塞技术对前交通动脉瘤破裂患者认知功能的影响[J].介入放射学杂志,2016, 25(5):374-376. DOI:10.3969/j.issn.1008-794X.2016.05.002.
[14] Yu H, Zhan R, Wen L, et al. The relationship between risk factors and prognostic factors in patients with shuntdependent hydrocephalus after aneurysmal subarachnoid hemorrhage[J].J Craniofac Surg, 2014,25(3):902-906.DOI:10.1097/SCS.0000000000000561.
[15] Uozumi Y, Sakowitz 0, Orakcioglu B, et al. Decompressive craniectomy in patients with aneurysmal subarachnoid hemorrhage:A single-center matched-pair analysis[J].Cerebrovasc Dis,2014,37(2):109-115.DOI:10.1159/000356979.
[2]孙久君,何朝晖,唐玖宁,等.血红蛋白浓度与动脉瘤性蛛网膜下腔出血术后症状性脑血管痉挛的相关研究[J].中国神经精神疾病杂志, 2014, 40(5):275-278.DOI:10.3936/j.issn.1002-0152.2014.05.004.
[3]彭四维,漆松涛,冯文峰,等.早期终板造瘘治疗动脉瘤性蛛网膜下腔出血后急性脑积水的疗效[J].中华神经外科杂志, 2015, 31(2):169-172. DOI:10.3760/cma.j.issn.1001-2346.2015.02.020.
[4]Liang, C W, Chen R, Macri E, et al. Preadmission beta-blockers are associated with decreased incidence of neurogenic stunned myocardium in aneurysmal subarachnoid hemorrhage[J]. J Stroke Cerebrovasc Dis,2013, 22(5):601-607. DOI:10.1016/j.jstrokecerebrovas dis.2011.10.006.
[5]赵经纬,罗旭颖,徐明,等.全面无反应量表在重症动脉瘤性蛛网膜下腔出血预后评估中的应用[J].首都医科大学学报, 2018, 39(1):28-34. DOI:10.3969/j.issn.1006-7795.2018.01.006.
[6]李爱国,刘之彝,龙晓东,等.颅内动脉瘤介入栓塞术和颅内夹闭术治疗高分级动脉瘤性蛛网膜下腔出血的临床疗效观察[J].临床外科杂志, 2018, 26(7):497-500. DOI:10.3969/j.issn.1005-6483.2018.07.007.
[7]陈平,苗壮,韩海玲,等.栓塞及夹闭治疗老年动脉瘤性蛛网膜下腔出血患者安全性及有效性的Meta分析[J].中国老年学杂志, 2018, 38(9):2057-2059.DOI:10.3969/j.issn.1005-9202.2018.09.004.
[8]胡新永,来海鸥,姬利,等.夹闭及栓塞治疗颅内动脉瘤对蛛网膜下腔出血患者脑血管痉挛及神经功能的[1][2][3][4][5][6][7][8]影响[J].广西医科大学学报, 2017, 34(1):100-102.DOI:10.16190/j.cnki.45-1211/r.2017.01.026.
[9]何士科.介入栓塞术与颅内夹闭术治疗高分级动脉瘤性蛛网膜下腔出血的临床分析[J].中华全科医学,2017,15(6):974-976. DOI:10.16766/j.cnki.issn.1674-4152.2017.06.020.
[10] Lin N, Zenonos G, Kim A H, et al. Angiogram-negative subarachnoid hemorrhage:relationship between bleeding pattern and clinical outcome[J]. Neurocrit Care, 2012,16(3):389-398. DOI:10.1007/s12028-012-9680-6.
[11]李刚,曹芳,焦松,等.弹簧圈瘤腔内栓塞与动脉瘤颈夹闭术治疗高分级动脉瘤性蛛网膜下腔出血的效果对比[J].中国老年学杂志,2017,37(22):5587.5589. DOI:10.3969/j.issn.1005-9202.2017.22.044.
[12] Ishihara H, Kunitsugu I, Nomura S, et al. Seasonal variation in the incidence of aneurysmal subarachnoid hemorrhage associated with age and gender:20-year results from the yamaguchi cerebral aneurysm registry[J]. Neuroepidemiology, 2013, 41(1):7-12. DOI:10.1159/000345247.
[13]李俊君,路华.不同介入栓塞技术对前交通动脉瘤破裂患者认知功能的影响[J].介入放射学杂志,2016, 25(5):374-376. DOI:10.3969/j.issn.1008-794X.2016.05.002.
[14] Yu H, Zhan R, Wen L, et al. The relationship between risk factors and prognostic factors in patients with shuntdependent hydrocephalus after aneurysmal subarachnoid hemorrhage[J].J Craniofac Surg, 2014,25(3):902-906.DOI:10.1097/SCS.0000000000000561.
[15] Uozumi Y, Sakowitz 0, Orakcioglu B, et al. Decompressive craniectomy in patients with aneurysmal subarachnoid hemorrhage:A single-center matched-pair analysis[J].Cerebrovasc Dis,2014,37(2):109-115.DOI:10.1159/000356979.