血管内栓塞联合显微外科治疗重症动脉瘤性蛛网膜下腔出血的临床研究

目的研究重症动脉瘤性蛛网膜下腔出血的患者（Hunt-Hess分级Ⅳ~Ⅴ级）采用超早期血管内联合显微外科治疗方式的临床疗效。方法收集2007年6月至2010年6月住院病例中符合研究标准的重症动脉瘤性蛛网膜下腔出血患者13例,行超早期行数字减影血管造影（DSA）检查,明确病变部位后根据结果选择合适方法对动脉瘤行血管内治疗、显微外科处置。术后6个月以G lasgow（GOS）评分分级及影像学检查为指标进行疗效分析。结果 6个月后GOS评分显示：死亡1例（7.7%）;植物状态1例（7.7%）;严重残疾4例（30.8%）;中度残疾4例（30.8%）;恢复良好3例（23.1%）。结论通过血管内栓塞联合显微外科治疗,可以显著降低重症动脉瘤性蛛网膜下腔出血的病死率、致残率,提高患者的生存质量。

The clinical study of the therapeutic effect of embolism within blood vessule combined with microsurgery on severe aneurysmal subarachnoid hemorrbage

Objective To observe the therapeutic effects of ultra-early endovascular therapy combined with microsurgery on severe aneurysmal subarachnoid hemorrhage(Hunt-Hess grades Ⅳ-Ⅴ).Methods 13 patients with severe aneurysmal subarachnoid hemorrhage were admitted to our hospital from June 2007 to June 2010.These patients received appropriate endovascular embolism therapy combined with microsurgery after they were examined by ultra-early cerebral digital subtraction angiography(DSA).The outcomes were assessed by GOS grading and imaging after 6-month treatment.Results The GOS grading after 6-month treatment showed that 1 patient(7.7%) died(D),1 patient(7.7%) was in a vegetative state(VS),4 patients(30.8%) were severely disabled(SD),4 patients(30.8%) were moderately disabled(MD),3 patients(23.1%) had good recovery(GR).Conclusion The ultra-early endovascular embolism therapy combined with microsurgery can decrease obviously the mortality rate and mutilation rate,and can improve the survival quality of patients with severe aneurysmal subarachnoid hemorrhage.