摘要
目的探讨HuntHessⅢ级和Ⅲ级以上颅内动脉瘤性蛛网膜下腔出血(SAH)患者的手术治疗时机和技巧,以提高分级不良患者的治疗效果。方法对116例分级不良的动脉瘤性SAH患者进行回顾性分析。按手术时机分为早期手术组(SAH后72h内)27例,间期手术组(SAH后72h至14d)12例和延期手术组(SAH14d后)51例。疗效以随访1年以上的格拉斯哥预后(GOS)评分评定。结果HuntHessⅢ级90例,手术治疗79例,随访62例。早期手术、间期手术和延期手术组的预后不良比分别为5/17、3/9和11.11%(4/36),P<0.001。未手术11例,均在22d内死亡。Ⅳ级16例,手术治疗8例,术后早期死亡3例,随访到4例,早期手术的2例中GOS4分1例,GOS1分1例;延期手术者2例,均GOS4分。Ⅴ级10例,早期手术3例,其中GOS3分1例、2分1例、1分1例;未手术7例,均为GOS1分。结论对于HuntHessⅢ级患者,延期手术的结果优于早期手术和间期手术,其中间期手术最差。对于Ⅳ级患者,积极的手术治疗能明显提高患者生存率。早期手术虽可挽救部分Ⅴ级患者的生命,但预后均不良。
Objective To explore the timing of direct surgical operation, surgical skills and methods for treatment of poor-grade aneurysmal subarachnoid hemorrhage, in order to improve the therapeutic result of the these patients. Methods 116 poor-grade patients from 1994 to 2004 was analysed retrospectively. The surgical timing was`divided into the early (within 72 h), intermediate(72 h to 14 d) and delayed operation(after 14 d).The outcome was appraised by GOS grading after one year. Results Seventy-nine among 90 patients of Hunt-Hess grade Ⅲ underwent surgical operation,Sixty-two patients were on follow-up. The rate of poor result in the early, intermediate and delayed operation group were 29.41%(5/17)、33.33%(3/9)and 11.11%(4/36)respectively ^(P<0.001) . Eleven patients undergone conservative treatment were all dead in 22 days. Eight of 16 patients with Hunt-Hess grade Ⅳ were received surgical treatment,4 of them had poor results. Three among 10 patients of Hunt-Hess grade Ⅴ underwent early operation, 1 in GOS 3 score,1 in GOS 2 score, and 1 in GOS 1 score. The other 7 patients recieved conservative treatment, all of them were died. Conclusion About the patients of Hunt-Hess grade Ⅲ,the outcome of the delayed operation is superior to the other two groups. The outcome of intermediate operation is the worst. the grade Ⅳ patients, urgent operating therapy can reduce the mortality. ~even though, the prognosis of the grade Ⅴ patients is very poor.
出处
《中国脑血管病杂志》
CAS
2005年第5期202-205,共4页
Chinese Journal of Cerebrovascular Diseases
