颅内破裂动脉瘤手术时机的临床研究

目的 探讨颅内破裂动脉瘤不同手术时机患者的血清炎性因子水平变化及其临床意义。方法 回顾性分析2017年6月-2019年12月在本院神经外科确诊的颅内动脉瘤性蛛网膜下腔出血患者180例,根据医师建议和患者自愿分为早期治疗组(入院1～3 d进行手术治疗)和延期治疗组(入院4～14 d进行手术治疗),比较2组患者手术前后血清炎性细胞因子水平变化,并对2组患者的疗效和术后并发症发生情况进行比较。结果 手术前2组血清TNF-α,IL-6,IL-1β水平无显著差异(P>0.05); 2组术后第8 d血清TNF-α,IL-6,IL-1β水平均较术前有所降低(P<0.05); 早期治疗组术后第8 d血清TNF-α,IL-6,IL-1β水平显著低于延期治疗组(P<0.05)。早期治疗组的总有效率显著高于延期治疗组(P<0.05); 早期治疗组的恢复良好率显著高于延期治疗组(P<0.05); 早期治疗组的致残率显著低于延期治疗组(P<0.05)。2组重残率、植物生存率及病死率无显著差异(P>0.05)。早期治疗组的颅内感染和脑血管痉挛的发生率明显低于延期治疗组(P<0.05),脑积水和再出血的发生率没有显著差异(P>0.05)。结论 早期治疗的颅内破裂动脉瘤患者的术后血清炎性指标水平变化较显著,疗效及预后均较好,并发症发生率低; 血清炎性指标水平可能与患者的疗效和预后有关,可作为aSAH发生发展的预测指标。

Clinical investigation of different operating times of intracranial ruptured aneurysms

ObjectiveTo explore clinical significance of serum inflammatory factor level changes in patients with intracranial ruptured aneurysms at different operating times.Methods A retrospective analysis of 180 patients with intracranial aneurysm in our hospital from June 2017 to December 2019 was divided into the early treatment group(1～3 d after admission, surgical treatment)and the delayed treatment group(surgery was performed 4～14 days after admission)according to the physician’s recommendation and the patients’ willingness. Serum inflammatory cytokine level changes before and after surgery were compared between the two groups, and the efficacy and postoperative complications were compared between the two groups.Results Before surgery, there was no significant difference in serum TNF-α, IL-6, and IL-1β levels between the two groups(P>0.05). Serum TNF-α, IL-6, and IL-1β levels were decreased at the 8^th d after operation(P<0.05). Serum TNF-α, IL-6, and IL-1β levels in the early operation group were significantly lower than those in the delayed operation group at the 8^th d after operation(P<0.05). The total effective rate of treatment in the early treatment group was significantly higher than that in the delayed treatment group(P<0.05). The recovery rate in the early treatment group was significantly higher than that in the delayed operation group(P<0.05). The residual rate in the early treatment group was significantly lower than that in the delayed treatment group(P<0.05). There were no notable differences in severe disability, plant survival and mortality between the two groups(P>0.05). The incidence of intracranial infection and cerebral vasospasm in the early operation group was significantly lower than that in the delayed surgery group(P<0.05). There was no notable difference in the incidence of hydrocephalus and rebleeding(P>0.05).Conclusion Early surgery had better clinical efficacy and prognosis compared with delayed surgery, and it was also safer and worthy of clinical application.