早期与延迟介入治疗对颅内破裂动脉瘤患者的疗效和DCI发生率的差异

目的探讨不同介入治疗时机对颅内破裂动脉瘤患者的疗效及迟发性脑缺血（DCI）发生率的影响，并分析导致术后DCI发生的危险因素。 方法回顾性分析自2014年1月至2018年6月于右江民族医学院附属医院神经外科行介入治疗的颅内破裂动脉瘤患者98例的临床资料，按照介入手术的时机将所有患者资料分为早期组（n=57）和延迟组（n=41）。其中所有患者均在常规治疗的基础上行介入治疗，其中早期组介入时间在发病后72 h内，而延迟组介入时间超过发病后72 h。比较2组患者治疗效果，术后并发症及预后情况之间的差异，并对导致患者术后DCI的危险因素进行单因素及多因素Logistic分析。 结果2组患者治疗后2周时NIHSS评分之间差异无统计学意义（6.27±2.19 vs 5.76±1.94，P>0.05），早期组完全栓塞率显著高于延迟组（91.23% vs 73.17%，P<0.05），2组患者术后DCI、CVS、再破裂出血、脑水肿及下肢静脉栓塞发生率差异无统计学意义（P>0.05），早期组随访3个月时预后良好率及巴塞尔指数评分显著高于延迟组80.70% vs 70.73%，（63.51±13.42）vs （52.78±12.65），P<0.05]，本次研究中患者治疗后DCI发生率为12.44%，低蛋白血症、Fisher分级Ⅲ~Ⅳ及WFNS分级Ⅲ~Ⅴ级是DCI发生的独立危险因素（OR=4.29、5.48、8.074，P<0.05）。 结论早期介入能提升栓塞效果的同时有效改善患者预后，低蛋白血症、Fisher分级Ⅲ~Ⅳ及WFNS分级Ⅲ~Ⅴ级是颅内动脉瘤介入术后发生DCI的独立危险因素。

Differences of efficacy and the incidence of DCI between early and delayed interventional therapy in patients with intracranial ruptured aneurysms

ObjectiveTo investigate the differences of efficacy and the incidence of delayed cerebral ischemia (DCI) between early and delayed interventional therapy in patients with intracranial ruptured aneurysms, and the risk factors leading to postoperative DCI. MethodsThe clinical data of 98 patients with intracranial ruptured aneurysm who underwent interventional therapy in our hospital from January 2014 to February 2018 were retrospectively analyzed. The patients were divided into early group (n=57) and delayed group (n=41) according to the timing of interventional surgery. All of the patients underwent interventional therapy based on conventional therapy. The early intervention time was within 72 h after the onset, while the delayed intervention time was more than 72 h after the onset. The differences in treatment outcomes, postoperative complications, and prognosis between the two groups were compared, and the multivariate logistic analyses were performed on the risk factors for postoperative DCI. ResultsThere was no significant difference in the NIHSS scores between the two groups at 7 d after treatment (6.27±2.19 vs 5.76±1.94, P>0.05). The complete embolization rate was significantly higher in the early group than in the delayed group (91.23% vs 73.17%, P<0.05). There was no significant difference in the incidence of postoperative DCI, CVS, rupture in hemorrhage, cerebral edema and lower extremity venous thrombosis between the two groups (P>0.05). The prognosis rate and Barthel index score were significantly higher in the early group at 3 months than in the delayed group (80.70% vs 70.73%, 63.51±13.42 vs 52.78±12.65, P<0.05). The incidence of DCI after treatment in this study was 12.44%. Hypoproteinemia, Fisher grade (Ⅲ-Ⅳ), and WFNS grade (Ⅲ-Ⅴ) were independent risk factors for DCI (OR=4.29, 5.48, 8.074, all P<0.05). ConclusionInterventional therapy is relatively effective in the treatment of patients with intracranial ruptured aneurysms, but early intervention can improve the embolization effect and improve the prognosis of patients, but the effect of postoperative DCI is not significant, leading to postoperative DCI. Hypoproteinemia, Fisher classification (Ⅲ-Ⅳ) and WFNS grade (Ⅲ-Ⅴ) are independent risk factors.