IV、V级颅内动脉瘤破裂综合治疗的临床研究

目的：分析血管内介入结合减压和引流手术治疗Hunt-Hess分级为IV、V级动脉瘤破裂出血的疗效及比较优势。方法：回顾性分析对28例IV、V级破裂动脉瘤血管内栓塞治疗,并先后给予脑室外、腰大池引流、血肿清除治疗。结果：恢复良好、轻残者16例,占57.1%;重残、植物生存者8例,占28.6%;死亡4例占14.3%。结论：破裂动脉瘤IV、V级患者可结合介入检查、治疗和针对脑室出血、颅内血肿、脑疝等情况的外科手术进行综合处理。介入治疗创伤小、适应证广、并发症少,应作为IV、V级破裂动脉瘤首选治疗方法。早期血管内栓塞治疗可以改善动脉瘤蛛网膜下腔出血IV-V患者的预后,结合减压和引流手术可显著降低死亡率、致残率。

Clinical Study of Comprehensive Treatment for Patients of Aneurismal Subarachnoid Hemorrhage in Hunt IV-V Grade

Objective：To analyze therapeutic efficacy,merits and demerits of endovascular interventional therapies with decompression and drainage surgery in the treatment of intracranial ruptured aneurysms of Hunt-HessIV-V grade.Method：28 aneurysms patients were treated by endovascular intervention;and also with external ventricular drainage,lumbar puncture and drainage as well as hematoma removal in the subsequent treatment, all the cases were studied retrospectively.Result：16 cases（57.1%）got in a good recovery or mild disability,8 cases（28.6%）in severe disability or persistent vegetative state,and 4 cases（14.3%）were in death,not resulting from interventional therapy.Conclusion：Patients of IV-V grade intracranial ruptured aneurysm,in an emergent state,should be treated aiming at specific complications such as ventricular hemorrhage,intracranial hematoma,cerebralhernia,and so on.Endovascular interventional therapies ought to be performed immediately,and endovascular intervention with the subsequent surgical treatment is preferable because of the advantages of smaller invasion,more indications and fewer complications.The treatment of inchoate endovascular embolization can improve the prognosis of patients of aneurismal SAH in Hunt IV-V grade,which combined with decompression and drainage surgery can decrease the disabled and death rates.