脑血管痉挛和手术时机对颅内破裂动脉瘤患者预后的影响

目的探讨脑血管痉挛(CVS)和手术时机对颅内破裂动脉瘤患者预后的影响。方法回顾性分析2008年11月至2009年3月经手术夹闭的71例颅内破裂动脉瘤患者的临床资料。利用经颅多普勒超声监测CVS,并分析CVS、手术时机与术中动脉瘤破裂发生率、术后主要并发症(CVS、脑积水)发生率和术后疗效(GOS评分)的关系。结果出院当天按GOS进行术后短期疗效评价,其中良好(GOS4～5分)54例,差(GOS2～3分)12例,死亡(GOS1分)5例。术前不同程度CVS患者术中动脉瘤破裂发生率、术后CVS和脑积水发生率以及患者预后良好率均无明显差异(P>0.05)。不同手术时期患者术中动脉瘤破裂发生率、术后并发症(CVS和脑积水)和患者预后良好率亦无明显差异(P>0.05)。中期手术患者中术前轻度或无CVS患者术后CVS的发生率显著低于术前中、重度CVS患者(P<0.05)。结论术前CVS程度和手术时机对颅内破裂动脉瘤患者总体预后并无显著影响;选择中期手术亦可以获得良好的治疗效果。

Relationship of preoperative cerebral vasospasm and surgical timing with the prognoses in patients with ruptured intracranial aneurysms

Objective To investigate the relationship of cerebral vasospasm(CVS) and surgical timing with the progress in patients with ruptured intracranial aneurysms.Methods The clinical data of 71 patients with ruptured intracranial aneurysms undergoing microsurgery in Tongji Hospital from November,2008 to March,2009,were analyzed retrospectively.CVS was detected by transcranial Doppler ultrasound(TCD).The impact of preoperative CVS and surgical timing on the occurrent rate of intraoperative aneurysmal rupture,the main postoperative complications(including CVS and hydrocephalus) and outcome assessed by GOS were analyzed.Results The preoperative CVS and surgical timing were insignificantly related to the occurent rates of introperative aneurysmal rupture and main postoperative complications and outcomes(P >0.05).The rate(33.3%) of postoperative CVS was significantly higher in the patients with preoperative moderate and severe CVS than that(13.6%) in the patients without or with preoperative mild CVS(P <0.05).Conclusions Maybe the ruptured intracranial aneurysms patients with mild CVS can be operated during the intermediate phase.The degree of preoperative CVS monitored by TCD was helpful to surgical timing in the patients with ruptured intracranial aneurysms.