[1]黄德俊,孙阳阳,万定,等.颅内破裂动脉瘤血管内介入治疗时机的选择及其对病人预后的影响[J].中国临床神经外科杂志,2022,27(08):637-639.[doi:10.13798/j.issn.1009-153X.2022.08.004]
 HUANG De-jun,SUN Yang-yang,WAN Ding,et al.Timing of endovascular intervention for patients with ruptured intracranial aneurysm and its effect on patients' prognoses[J].,2022,27(08):637-639.[doi:10.13798/j.issn.1009-153X.2022.08.004]
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颅内破裂动脉瘤血管内介入治疗时机的选择及其对病人预后的影响()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
27
期数:
2022年08期
页码:
637-639
栏目:
论著
出版日期:
2022-08-31

文章信息/Info

Title:
Timing of endovascular intervention for patients with ruptured intracranial aneurysm and its effect on patients' prognoses
文章编号:
1009-153X(2022)08-0637-03
作者:
黄德俊孙阳阳万定冯进杨振兴李小龙尹姬
750004 银川,宁夏医科大学总医院神经外科(黄德俊、万定、冯进、杨振兴),介入放射科(尹姬);750004 银川,宁夏医科大学研究生院(孙阳阳、李小龙)
Author(s):
HUANG De-jun1 SUN Yang-yang2 WAN Ding1 FENG Jin1 YANG Zhen-xing1 LI Xiao-long2 YU Ji3
1. Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China; 2. Graduate School of Ningxia Medical University, Yinchuan 750004, China; 3. Department of Interventional Radiology, General Hospital of Ningxia Medical University, Yinchuan 750004, China
关键词:
颅内破裂动脉瘤蛛网膜下腔出血血管内治疗预后手术时机
Keywords:
Ruptured intracranial aneurysm Subarachnoid hemorrhage Endovascular treatment Prognosis Surgical timing
分类号:
R743.9;R815.2
DOI:
10.13798/j.issn.1009-153X.2022.08.004
文献标志码:
A
摘要:
目的 探讨颅内破裂动脉瘤血管内介入治疗时机的选择及其对病人预后的影响。方法 回顾性分析2018年1月至2020年6月血管内介入治疗的149例颅内破裂动脉瘤的临床资料。手术时机分为早期手术(≤72 h)和晚期手术(>72 h)。术后随访6个月,采用改良Rankin量表(mRS)评分评估预后,其中0~2分为预后良好,3~6分为预后不良。结果 术后6个月,110例(73.8%)预后良好;39例(26.2%)预后不良,其中死亡12例。本文149例中,早期手术96例,晚期手术53例。早期手术预后良好率(82.3%,79/96)明显高于晚期手术(55.4%,31/56;P<0.05)。多因素logistic回归分析显示,晚期手术是颅内破裂动脉瘤预后不良的独立危险因素(P<0.05)。结论 对于颅内破裂动脉瘤,早期手术可改善病人的预后。
Abstract:
Objective To investigate the Timing of endovascular intervention for patients with ruptured intracranial aneurysm (RIA) and its effect on patients' prognoses. Methods The clinical data of 149 patients with RIA who underwent endovascular embolization from January 2018 to June 2020 were analyzed retrospectively. The timing of embolization was classified as early embolization (≤72 h) and late embolization (>72 h). The patients were followed up for 6 months, and the patients' prognoses were assessed by the modified Rankin Scale (mRS) score, with a mRS score of 0~2 as good prognosis and score of 3~6 as poor prognosis. Results Of 149 patients, 110 patients (73.8%) had good prognoses and 39 (26.2%) poor prognoses, including 12 deaths. Of these 149 patients, 96 patients received early embolization and 53 late embolization. The good prognosis rate of patients undergoing early surgery (82.3%, 79/96) was significantly higher than that of patients undergoing late surgery (55.4%, 31/56; P<0.05). Multivariate logistic regression analysis showed that late embolization was an independent risk factor for poor prognosis of patients with ruptured intracranial aneurysm (P<0.05). Conclusions Early endovascular embolization can improve the prognoses of patients with RIA.

参考文献/References:

[1]河南省医师协会神经介入专业委员会,河南省微循环学会神经重症分会. 《高分级动脉瘤性蛛网膜下腔出血综合救治》试行方案中原区域专家共识[J]. 中国临床神经外科杂志,2022,27(6):513-521.
[2]谢昌纪,周志宇,韦成聪. 颅内动脉瘤破裂出血后脑血管痉挛发病机制的研究进展[J]. 中国临床神经外科杂志,2021,26(9):727-728.
[3]李 斐,陈谦学,柳再明,等. 颅内动脉瘤破裂并发脑内血肿的危险因素[J]. 中国临床神经外科杂志,2019,24(5):266-268.
[4]史祥玉,王守森,望家兴,等. SII和PNI与动脉瘤性蛛网膜下腔出血预后的关系[J]. 中国临床神经外科杂志,2022,27(3):167-170.
[5]许锡镇,余军武,吾太华,等. 眉弓锁孔技术在前交通动脉破裂动脉瘤夹闭术中的应用[J]. 中国临床神经外科杂志,2021,26(11):868-869.
[6]孙连杰,冯冠军,吴红星,等. 改良Paine点脑室穿刺术在颅内前循环破裂动脉瘤急性期夹闭术中的应用[J]. 中国临床神经外科杂志,2021,26(12):918-920.
[7]Steiner T, Juvela S, Unterberg A, et al. European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage [J]. Cerebrovasc Dis, 2013, 35(2): 93-112.
[8]周 根,李彦钊,邓东风,等. 高级别颅内动脉瘤保守治疗后行血管内栓塞治疗的预后观察[J]. 中华脑科疾病与康志(电子版),2018,8(1):33-36.
[9]曾志斌,沈比先,陈胜基,等. 两种时机介入栓塞治疗颅内动脉瘤的疗效对比[J]. 临床医学工程,2018,25(4):483-484.
[10]Cho WS, Kim JE, Park SQ, et al. Korean Clinical Practice Guidelines for Aneurysmal Subarachnoid Hemorrhage [J]. J Korean Neurosurg Soc, 2018, 61: 127-166.
[11]Pang JW, Peng JH, Yang P, et al. White matter injury in early brain injury after subarachnoid hemorrhage [J]. Cell Transplant, 2019, 28(1): 26-35.
[12]Wong GKC, Boet R, Ng SCP, et al. Ultra-early (within 24 hours) aneurysm treatment after subarachnoid hemorrhage [J]. World Neurosurg, 2012, 77(2): 311-315.
[13]黄明火,熊学辉,魏小川,等. 动脉瘤破裂致蛛网膜下腔出血24 h内微弹簧圈栓塞干预的预后分析[J]. 中华神经创伤外科电子杂志,2019,5(3):155-158.
[14]Zhao B, Tan X, Zhao Y, et al. Variation in patient characteristics and outcomes between early and delayed surgery in poor-grade aneurysmal subarachnoid hemorrhage [J].
Neurosurgery, 2016, 78(2): 224-231.
[15]Molyneux AJ, Kerr RSC, Yu LM, et al. International sub-arachnoid aneurysm trial [ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured
intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion [J]. Lancet, 2005, 366: 809-817.
[16]秦尚振,马廉亭,杨 铭,等. 高级别颅内动脉瘤治疗策略探讨[J]. 中华神经外科杂志,2013,29(9):916-919.

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备注/Memo

备注/Memo:
(2021-09-02收稿,2022-07-24修回)
基金项目:宁夏回族自治区科学技术厅重点研发项目(2018YBZD0034)
通信作者:黄德俊,E-mail:hdj1225@163.com
更新日期/Last Update: 2022-09-30