Clinical analysis of effect of interventional embolization and intracranial clamp operation in patients with high-grade aneurysmal subarachnoid hemorrhage
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摘要: 目的 临床对开颅术和介入术治疗高分级动脉瘤性蛛网膜下腔出血(aSAH)的效果仍存在争议。本研究通过探讨介入栓塞术与颅内夹闭术治疗高分级aSAH的临床疗效为临床提供依据。 方法 选取2011年6月-2016年5月于丽水市中心医院神经外科进行治疗的高分级动脉瘤性蛛网膜下腔出血患者90例,依据治疗方法的不同将其分为观察组和对照组。观察组49例,行介入栓塞术治疗,对照组41例,行颅内夹闭术治疗。观察并比较2组患者免疫球蛋白A(IgA)、IgG、IgM水平、住院时间、并发症情况及短期疗效。 结果 2组患者治疗前IgA、IgG、IgM水平差异均无统计学意义(P>0.05),2组患者手术24 h后IgA、IgG、IgM水平均较手术前明显降低(P<0.05),但对照组患者IgA、IgG、IgM降低更显著(P<0.05);观察组患者住院时间、脑血管痉挛发生率均明显低于对照组(P<0.05),但2组患者再出血、脑积水、颅内感染的发生率差异无统计学意义(P>0.05);观察组患者短期预后良好率为71.43%,对照组患者短期预后良好率为48.78%,观察组患者短期预后良好率明显高于对照组(P<0.05)。 结论 介入栓塞术治疗高分级aSAH短期治疗效果更佳,对患者免疫功能影响更小,且可明显缩短住院时间,有助于减少脑血管痉挛的发生率。
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关键词:
- 介入栓塞术 /
- 颅内夹闭术 /
- 高分级动脉瘤性蛛网膜下腔出血 /
- 免疫球蛋白 /
- 脑血管痉挛
Abstract: Objective High-grade aneurysmal subarachnoid hemorrhage (aSAH) has high morbidity and mortality,craniotomy and interventional operation is the main treatment,but their effect is still controversial.The aim of this study is to explore the efficacy of interventional embolization,and to provide the basis for clinical treatment in patients with aSAH. Methods A total of 90 patients with high-grade aneurysmal subarachnoid hemorrhage were divided into observation group (49 cases) and control group (41 cases) from June,2011 to May,2016.The patients of the observation group received interventional embolization,while the control group received surgical clipping of a cerebral aneurysm.The levels of IgA,IgG and IgM,hospitalization time,complications and short-term efficacy were compared between 2 groups. Results The levels of IgA,IgG and IgM had no significant difference between the two groups before the operation (P>0.05);as compared with the levels before operation,the levels of IgA,IgG and IgM decreased significantly at 24 h after the operation in both groups (P<0.05),and the control group decreased more significantly than those of the observation group (P<0.05).The hospitalization time and cerebral vasospasm incidence in the observation group was significantly lower than that in the control group (P<0.05),but the incidence of rehemorrhage,hydrocephalus and intracranial infection had no significant difference between the two groups before the operation (P>0.05);The short-term better prognosis rate of the observation group was 71.43%,which was significantly higher than that of the control group (48.78%),P<0.05. Conclusion Interventional embolization has better short-term efficacy on high grade aneurysmal subarachnoid hemorrhage with less influence on immunologic function.It can shorten the length of hospital time,reduce the incidence of cerebral vasospasm.
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