急诊手术对控制颅内动脉瘤病情和改善预后的影响

目的探讨血管内栓塞介入与显微急诊手术在颅内动脉瘤治疗中的效果及在改善预后中的作用。 方法选择2015年4月至2017年7月自愿到青岛市西海岸新区人民医院神经外科接受治疗的颅内动脉瘤患者106例为研究对象，其中男性59例，女性47例；年龄27～76岁，平均(45.69±6.33)岁，进行回顾性分析。按随机数字法将106例患者分为对照组和观察组，每组53例。对照组采用急诊血管内栓塞介入治疗，观察组采用急诊显微手术治疗。采用酶联免疫吸附试验测定两组患者手术前后静脉血肿瘤坏死因子－α(TNF－α)和白细胞介素－6(IL－6)水平；比较两组患者术后恢复良好、残疾、植物人及死亡情况。 结果两组患者手术前后TNF－α观察组：(36.94±4.27)ng/mL比(135.61±12.51)ng/mL；对照组：(38.12±4.31)ng/mL比(134.05±12.39)ng/mL]及IL－6观察组：(1.05±0.47)ng/mL比(7.93±1.35)ng/mL；对照组：(1.07±0.49)ng/mL比(7.95±1.36)ng/mL]水平均较术前明显下降，但两组间术后TNF－α及IL－6水平差异无统计学意义TNF－α：(36.94±4.27)ng/mL比(38.12±4.31)ng/mL，IL－6：(1.05±0.47)ng/mL比(1.07±0.49)ng/mL，P>0.05)]。观察组患者术后治愈77.36%、恢复良好率13.21%，均高于对照组(P<0.05)；观察组残疾率、植物生存发生率及病死率均低于对照组(P均<0.05)。 结论血管内栓塞介入和急诊显微手术均能控制颅内动脉瘤患者病情，但是急诊显微手术能获得更佳的手术预后，死亡率更低，值得推广应用。

Efficacy of emergency surgery on controlling the condition and improving prognosis of patients with intracranial aneurysms

ObjectiveTo investigate the effect of intravascular embolization intervention and microsurgery in the treatment of intracranial aneurysms and its role in improving the prognosis. MethodsA total of 106 patients with intracranial aneurysms treated with neurosurgery from April 2015 to July 2017 who had volunteered to receive treatment at the People’s Hospital of West Coast New District of Qingdao were selected. Among them, 59 were males and 47 were females, aged 27 to 76 years. The mean age was(45.69±6.33)years and a prospective randomized controlled study was conducted. This study was approved by the Ethics Committee of the People’s Hospital of West Coast New District of Qingdao City. Patients and their families have the right to know about the surgical plan. According to the random number method, 106 patients were divided into control group and observation group, 53 cases in each group. The control group was treated with emergency endovascular embolization and the observation group was treated with emergency microsurgery. Enzyme-linked immunosorbent assay was used to compare the levels of TNF-α and IL-6 in venous blood before and after surgery in both groups; The number of vegetative and death cases was compared with the effect of different surgical methods on the prognosis of patients. ResultsPre- and Postoperative TNF-αin both groups Observation group: (36.94±4.27)ng/mL ratio(135.61±12.51)ng/mL; Control group: (38.12±4.31)ng/mL ratio(134.05±12.39)ng/ mL] and IL-6 Observation group: (1.05±0.47)ng/mL ratio(7.93±1.35)ng/mL; Control group: (1.07±0.49)ng/mL ratio(7.95±1.36)ng/mL] were compared. The postoperative levels of TNF-αand IL-6were significantly lower than that before surgery, but there were no significant differences in TNF-α and IL-6 levels between the two groups. TNF-α: (36.94±4.27)ng/mL ratio(38.12±4.31)ng/ mL, IL-6: (1.05±0.47)ng/mL ratio(1.07±0.49)ng/mL, P>0.05)]. The patients in the observation group had better cure and recovery rates after surgery than those in the control group (P<0.05). The observation group had lower rates of disability, vegetative events and mortality than the control group (P<0.05). ConclusionBoth endovascular embolization and emergency microsurgery can control the condition of patients with intracranial aneurysms. However, emergency microsurgery can obtain better operative prognosis and lower mortality. It is worthy of popularization and application.