CAJ | 학술논문

目的探讨Hunt-Hess高分级颅内动脉瘤血管内栓塞治疗的临床疗效及应用价值.方法 2001年5月至2010年2月采用血管内栓塞治疗87例颅内动脉瘤,Hunt-Hess Ⅳ级77例,Ⅴ级10例.以格拉斯哥预后分级(GOS)评估预后.结果随访3个月至9年.GOS结果:Ⅰ级25例,Ⅱ级5例,Ⅲ级9例,Ⅳ级12例,Ⅴ级36例,预后良好率55.17%(48/87),病死率28.74%(25/87).47例早期(发病后3 d内)治疗患者预后良好率61.70%(29/47),病死率25.53%(12/47);40例中晚期(发病后3d及以后)治疗患者预后良好率47.50%(19/40),病死率32.50%(13/40).早期治疗患者和中晚期治疗患者预后良好率和病死率比较差异均无统计学意义(P＞0.05).87例患者均能成功栓塞治疗,技术并发症8例.脑血管造影发现血管痉挛1O例.结论血管内栓塞是治疗Hunt-Hess高分级颅内动脉瘤有效方法,早期治疗可行、有效,能通过减少动脉瘤再破裂出血和防治血管痉挛提高预后.
목적 탐토Hunt-Hess고분급로내동맥류혈관내전새치료적림상료효급응용개치.방법 2001년5월지2010년2월채용혈관내전새치료87례로내동맥류,Hunt-Hess Ⅳ급77례,Ⅴ급10례.이격랍사가예후분급(GOS)평고예후.결과 수방3개월지9년.GOS결과:Ⅰ급25례,Ⅱ급5례,Ⅲ급9례,Ⅳ급12례,Ⅴ급36례,예후량호솔55.17%(48/87),병사솔28.74%(25/87).47례조기(발병후3 d내)치료환자예후량호솔61.70%(29/47),병사솔25.53%(12/47);40례중만기(발병후3d급이후)치료환자예후량호솔47.50%(19/40),병사솔32.50%(13/40).조기치료환자화중만기치료환자예후량호솔화병사솔비교차이균무통계학의의(P＞0.05).87례환자균능성공전새치료,기술병발증8례.뇌혈관조영발현혈관경련1O례.결론 혈관내전새시치료Hunt-Hess고분급로내동맥류유효방법,조기치료가행、유효,능통과감소동맥류재파렬출혈화방치혈관경련제고예후.
Objective To explore the clinical therapeutic efficacy and value of endovascular embolization treatment for Hunt-Hess poor-grade intracranial aneurysms. Methods Eighty-seven patients with Hunt-Hess grade Ⅳ - Ⅴ intracranial aneurysrns were treated with endovascular embolization from May 2001 to February 2010,77 patients were grade Ⅳ and 10 patients were grade Ⅴ. Outcomes were assessed by using the Glasgow outcome scale (GOS). Results Follow-up time was from 3 months to 9 years. The therapeutic efficacy was as following according to GOS: 25 patients were grade Ⅰ , 5 patients were grade Ⅱ , 9 patients were grade Ⅲ , 12 patients were grade Ⅳ ,and 36 patients were grade Ⅴ. There were 55.17%(48/87) favorable outcome rate and 28.74% (25/87) mortality rate in all patients. There were 61.70%(29/47) favorable outcome rate and 25.53%(12/47) mortality rate in early stage treatment patients (diseased within 3 d), otherwise there were 47.50% (19/40) favorable outcome rate and 32.50%(13/40) mortality rate in medium and late stage treatment patients (diseased 3 d or later). There were no statistically significance in favorable outcome rate and mortality rate between them (P > 0.05). All the patients were embolized successfully ,technical complications occurred in 8 patients, 10 patients were found angiographic evidence of vasospasm. Conclusions Endovascular embolization is an effective method for treating Hunt-Hess poorgrade intracranial aneurysms. Early stage treatment is a feasible option because it can improve prognosis by reducing rebleeding and vasospasm.