破裂颅内动脉瘤早期治疗的必要性

目的探讨破裂颅内动脉瘤早期治疗的必要性。方法首次破裂出血的颅内动脉瘤(Hunt-HessⅠ-Ⅳ级)患者62例,其中13例入院后发生再出血。采用单独开颅手术夹闭25例,单独介入栓塞27例,两者结合治疗3例。7例再出血者Hunt-Hess分级转为Ⅴ级,行保守治疗。预后评价采用GOS评分。结果本组再出血率为20.97%。再出血组13例中预后良好5例(38.5%),较差8例(61.5%);未出血组预后良好42例(85.7%),较差7例(14.3%);两组比较,P(0.05。4例术后有明确血管痉挛者1例预后良好,3例较差。早期(3日以内)治疗组21例,预后良好19例(90.48%);中期(3日～2周)治疗组24例,预后良好17例(70.83%);晚期(2周以上)治疗组10例,预后良好6例(60.00%),早期治疗组和中晚期相比,P(0.05。结论对于破裂颅内动脉瘤患者,早期及时进行干预治疗是防止再出血的关键。

The significance of early treatment of ruptured intracranial aneurysm

Objective To explore the significance of the early surgical or interventional therapy of ruptured intracranial aneurysm.Methods 62 patients with ruptured intracranial aneurysm presenting primary subarachnoid hemorrhage（Hunt-Hesss ScaleⅠ-Ⅳ）were retrospectively analyzed,of which,rebleeding occurred in 13 cases during hospital stay.Out of the 62 patients,25 cases were treated with alone clipping,27 cases with alone interventional embolism,3 with combined surgical and interventional therapy.7 cases with rebleeding and in the status of Hunt-Hess Ⅴ were treated conservatively.The outcome was evaluated with GOS scale.Results In this series,the rebleeding rate is 21%,out of the 13 patients with rebleeding,good outcome occurred in 5 cases（38.5%）and bad outcome in 8 cases（61.5%）.In the patients without rebleeding,good outcome and bad outcome occurred in 42 cases（85.7%）and 7 cases（14.3%）respectively.The outcome is significantly different in the two groups.Out of the 4 patients with definite vasospasm,good outcome occurred in 1 case and bad outcome in 3 cases.Out of 21 cases treated early within 3 days（early group）,19cases got good outcome（90.48%）;24 cases treated from 3th day to 2 week（medium group）,17 cases recovered good（70.83%）;10 cases treated 2 weeks later（late group）,6 cases recovered good（60.00%）;compared with the medium and late groups,the outcome of early group got statistically significant.Conclusion It is necessary to treat the patient with ruptured intracranial aneurysm promptly to prevent rebleeding and the ensuing fatal consequences.