早期手术治疗破裂颅内动脉瘤合并急性神经源性肺水肿的临床效果
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摘要
目的分析早期手术和保守治疗对破裂颅内动脉瘤合并急性神经源性肺水肿(ANPE)的效果。方法回顾分析我院2013年1月至2018年7月收治的39例破裂颅内动脉瘤合并ANPE的患者的临床资料,将患者按治疗方式的不同将其分为早期组(22例)和保守组(17例)。早期组行早期破裂颅内动脉瘤手术治疗,保守组行单纯侧脑室引流等保守治疗。比较两组术后1个月内生存率、颅内动脉瘤破裂复发率、手术前、手术后24 h的血清脑钠肽(BNP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平、氧合指数、动脉血乳酸水平。结果早期组术后1个月内生存率高于保守组,颅内动脉瘤破裂复发率低于保守组(P<0.05)。手术后24 h,两组的BNP、IL-6和TNF-α水平均降低,且早期组均低于保守组(P<0.05)。手术后24 h,早期组的氧合指数高于术前及保守组,动脉血乳酸水平明显低于术前及保守组(P<0.05)。结论对合并ANPE的破裂颅内动脉瘤患者施行早期手术能有效提高患者生存率,降低颅内动脉瘤破裂复发率,改善患者氧合指数,降低动脉血乳酸、BNP、IL-6、TNF-α等炎症因子水平。
Objective To analyze the effect of early surgery and conservative treatment on ruptured intracranial aneurysms complicated with acute neurogenic pulmonary edema(ANPE). Methods The clinical data of 39 patients with ruptured intracranial aneurysms complicated with ANPE admitted in our hospital from January 2013 to July 2018 were retrospectively analyzed. According to the different treatment methods, patients were divided into early group(22 cases) and conservative group(17 cases). The early group underwent early surgical treatment of ruptured intracranial aneurysms, while the conservative group underwent conservative treatment such as simple lateral ventricle drainage. The survival rates, recurrence rates of intracranial aneurysm rupture within 1 month after operation, the levels of serum brain natriuretic peptide(BNP),interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), oxygenation indexes and arterial blood lactic acid before and 24 hours after operation were compared between the two groups. Results The survival rate within 1 month after operation of the early group was higher than that of the conservative group, and the recurrence rate of intracranial aneurysm rupture was lower than that of the conservative group(P<0.05). At 24 hours after operation, the levels of BNP, IL-6 and TNF-α in both groups decreased, and those in the early group were lower than the conservative group(P<0.05). At 24 hours after operation, the oxygenation index of the early group was higher than that before operation and the conservative group, and the level of arterial blood lactic acid was lower than that before operation and the conservative group(P<0.05). Conclusion Early surgery for ruptured intracranial aneurysms complicated with ANPE can effectively improve the survival rate of patients, decrease the recurrence rate of ruptured intracranial aneurysms complicated, improve the oxygenation index, and decrease the levels of arterial blood lactic acid, BNP, IL-6, TNF-α and other inflammatory factors.
Objective To analyze the effect of early surgery and conservative treatment on ruptured intracranial aneurysms complicated with acute neurogenic pulmonary edema(ANPE). Methods The clinical data of 39 patients with ruptured intracranial aneurysms complicated with ANPE admitted in our hospital from January 2013 to July 2018 were retrospectively analyzed. According to the different treatment methods, patients were divided into early group(22 cases) and conservative group(17 cases). The early group underwent early surgical treatment of ruptured intracranial aneurysms, while the conservative group underwent conservative treatment such as simple lateral ventricle drainage. The survival rates, recurrence rates of intracranial aneurysm rupture within 1 month after operation, the levels of serum brain natriuretic peptide(BNP),interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), oxygenation indexes and arterial blood lactic acid before and 24 hours after operation were compared between the two groups. Results The survival rate within 1 month after operation of the early group was higher than that of the conservative group, and the recurrence rate of intracranial aneurysm rupture was lower than that of the conservative group(P<0.05). At 24 hours after operation, the levels of BNP, IL-6 and TNF-α in both groups decreased, and those in the early group were lower than the conservative group(P<0.05). At 24 hours after operation, the oxygenation index of the early group was higher than that before operation and the conservative group, and the level of arterial blood lactic acid was lower than that before operation and the conservative group(P<0.05). Conclusion Early surgery for ruptured intracranial aneurysms complicated with ANPE can effectively improve the survival rate of patients, decrease the recurrence rate of ruptured intracranial aneurysms complicated, improve the oxygenation index, and decrease the levels of arterial blood lactic acid, BNP, IL-6, TNF-α and other inflammatory factors.
引文
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[9]杜绍楠,刘志.脑出血后神经源性肺水肿的相关因素分析[J].中国医科大学学报,2018,47(3):256-259.
[10]杨磊,张栋梁,韩永丰.心肌标志物预测动脉瘤性蛛网膜下腔出血导致的神经源性肺水肿价值[J].河北医药,2018,40(11):1650-1653.
[11]赵洪海,张丽,王芳,等.急性脑血管病并发神经源性肺水肿的影响因素及其临床特点研究[J].实用心脑肺血管病杂志,2017,25(5):24-28.
[12]段永红,廖勇仕,梁日初,等.早期手术治疗合并急性神经源性肺水肿的破裂颅内动脉瘤[J].国际神经病学神经外科学杂志,2018,45(3):230-233.
[13]张磊,蒋文芳,吕光宇.俯卧位通气治疗在重型颅脑损伤并重度神经源性肺水肿中的应用效果研究[J].实用心脑肺血管病杂志,2016,24(10):37-42.
[2]李启明,李瑾,张均,等.动脉瘤性蛛网膜下腔出血早期并发神经源性肺水肿的相关危险因素分析[J].内科急危重症杂志,2016,22(3):187-189.
[3]常朋飞,张磊,孙世中.神经源性肺水肿的诊治进展[J].武警后勤学院学报:医学版,2016,25(10):856-860.
[4]CLAASSEN J,BERNADINI GL,KREITER K,et al.Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrage:the Fisher scale revisited[J].Stroke,2001,32(9):2012-2020.
[5]HUNT WE,HESS RM.Surgical risk as related to time of intervention in the repair of intracranial aneurysms[J].J Neurosurg,1968,28(1):14-20.
[6]刘红升,苏琴,赵晓东,等.神经源性肺水肿早期形式的急诊识别及治疗[J].中国医学科学院学报,2015,37(3):343-347.
[7]吕行伟.重型颅脑外伤继发神经原性肺水肿的诊治体会[J].河南医学研究,2016,25(5):920-921.
[8]唐占军,段凯强,梁立,等.急性脑血管病并发神经源性肺水肿血清儿茶酚胺与炎性因子水平的相关性分析[J].临床合理用药,2016,9(2A):108-109.
[9]杜绍楠,刘志.脑出血后神经源性肺水肿的相关因素分析[J].中国医科大学学报,2018,47(3):256-259.
[10]杨磊,张栋梁,韩永丰.心肌标志物预测动脉瘤性蛛网膜下腔出血导致的神经源性肺水肿价值[J].河北医药,2018,40(11):1650-1653.
[11]赵洪海,张丽,王芳,等.急性脑血管病并发神经源性肺水肿的影响因素及其临床特点研究[J].实用心脑肺血管病杂志,2017,25(5):24-28.
[12]段永红,廖勇仕,梁日初,等.早期手术治疗合并急性神经源性肺水肿的破裂颅内动脉瘤[J].国际神经病学神经外科学杂志,2018,45(3):230-233.
[13]张磊,蒋文芳,吕光宇.俯卧位通气治疗在重型颅脑损伤并重度神经源性肺水肿中的应用效果研究[J].实用心脑肺血管病杂志,2016,24(10):37-42.