血管内介入治疗大脑动脉瘤对患者预后与应激反应的影响

目的探讨血管内介入治疗大脑动脉瘤对患者预后与应激反应的影响。方法选取2014年2月~2020年8月在本院诊治的大脑动脉瘤患者156例,随机分为介入组与夹闭组各78例。夹闭组给予开颅夹闭手术治疗,介入组给予血管内介入治疗,调查患者的预后情况并检测患者的应激反应指标表达变化情况。结果介入组的手术时间与术后住院天数少于夹闭组(P<0.05),住院费用多于夹闭组(P<0.05)。介入组术后14天的血管破裂出血、脑积水、血管痉挛、颅内感染等并发症发生率为2.6%,低于夹闭组的17.9%(P<0.05)。介入组术后14天的预后Glasgow状态好于夹闭组(P<0.05)。两组术前一天血清可溶性细胞间黏附分子-1(soluble intercellular adhesion molecule-1,sICAM-1)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平对比差异无统计学意义(P>0.05),介入组术后3天、术后7天、术后14天低于术前1天(P<0.05),介入组低于夹闭组(P<0.05)。结论相对于夹闭手术治疗,血管内介入治疗大脑动脉瘤能提高患者的近期疗效,减少术后并发症的发生,促进患者康复,其作用机制可能与降低患者的应激反应有关。

Effect of endovascular interventional therapy on patients with cerebral aneurysm on prognosis and stress response

Objective To investigate the effects of intravascular interventional therapy on patients with cerebral aneurysm on the prognosis and stress response.Methods From February 2014 to August 2020,156 patients with cerebral aneurysm who were diagnosed and treated in our hospital were selected as the research objects.All the cases were eqaully divided into the intervention group and clipping group according to the random envelope 11 lottery principle.The clipping group was given craniotomy and clipping surgery,and the intervention group was given endovascular interventional therapy.The prognosis of the patients was investigated and changes in the expression of stress response indicators were detected.Results The operation time and postoperative hospital stay of the interventional group were less than those of the clipping group(P<0.05),and the hospitalization expenses were more than those of the clipping group(P<0.05).The incidence of complications such as vascular rupture and hemorrhage,hydrocephalus,vasospasm,and intracranial infection in the interventional group at 14 days after operation were 2.6%,which were lower than 17.9%in the clipping group(P<0.05).The prognostic Glasgow status of the interventional group was better than that of the clipping group at 14 days after operation(P<0.05).There was no statistically significant difference in the levels of serum soluble intercellular adhesion molecule-1(sICAM-1)and tumor necrosis factor-α(TNF-α)compared between the two groups at 1 day before surgery(P>0.05),the intervention group was lower than the preoperative 1 d at 3 d,7 d and 14 d after the operation(P<0.05),and the intervention group was also lower than the clipping group(P<0.05).Conclusion Compared with the surgical treatment of clipping,endovascular interventional treatment of cerebral aneurysms can improve the curative effect of patients,reduce the occurrence of postoperative complications,and promote the recovery of patients.Its mechanism of action may be related to the reduction of patients’stress response.