颅内动脉瘤破裂出血急性期的外科综合治疗

目的通过对颅内动脉瘤破裂出血急性期的外科治疗,就其动脉瘤破裂急性期的治疗方法、围手术期处理和治疗策略进行探讨。方法对100例颅内动脉瘤破裂出血患者在发病3d内选择可控性微弹簧圈栓塞颅内囊性动脉瘤,带膜支架置入治疗梭形动脉瘤、宽颈动脉瘤或巨大动脉瘤以及显微手术夹闭。术后采用脑脊液引流等方法,积极治疗引起脑血管痉挛的病因,防止脑血管痉挛和脑出血。结果 100例颅内动脉瘤破裂出血患者,介入栓塞治疗72例,显微手术夹闭28例。术后98例临床痊愈,其治疗结果根据Glasgow预后评分:Ⅰ级76例,Ⅱ级13例,Ⅲ级7例,Ⅳ级2例,Ⅴ级2例。全组死亡2例,死亡率2%。结论颅内动脉瘤破裂出血应于急性期有选择地采用最佳的外科治疗,术后治疗的策略应着重于早期处理SAH,防治脑血管痉挛(CVS)及延迟性缺血性神经功能降碍(DIND)。

Combined modality of surgery therapy for acute intracranial ruptured aneurysm

【Objective】 To investigate the methods and effect of combined modality surgery therapy on acute intracranial ruptured aneurysm in preoperative period.【Methods】 100 patients have acute intracranial ruptured aneurysm in 3 days,treated by coiling or coiling with covered stent,or clipping,drainage of cerebrospinal fluid and prevention cerebral vasospasm after operation.【Results】 Among 100 cases,72 cases were treated with coiling,28 cases treated with clipping.98 cases were clinical recovery,2 cases dead.According to Glasgow Prognosis Score: 76 cases were gradeⅠ,13 cases were gradeⅡ,7 cases were grade Ⅲ,2 cases were grade Ⅳ,2 cases were grade Ⅴ.【Conclusion】 Acute intracranial ruptured aneurysm should be treated selectively by the optimal surgical therapy.After treatment,it is necessary to deal with subarachnoid hemorrhage,prevent cerebral vasospasm and delay ischemic neurofunction disability.