中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
2期
9-11
,共3页
李益萍%罗永春%何子骏%沈春森%毛锦龙%孟景山%袁春涛%马尚%张强%梁春阳%徐如祥
李益萍%囉永春%何子駿%瀋春森%毛錦龍%孟景山%袁春濤%馬尚%張彊%樑春暘%徐如祥
리익평%라영춘%하자준%침춘삼%모금룡%맹경산%원춘도%마상%장강%량춘양%서여상
颅内动脉瘤%蛛网膜下腔出血%栓塞,治疗性%超早期治疗
顱內動脈瘤%蛛網膜下腔齣血%栓塞,治療性%超早期治療
로내동맥류%주망막하강출혈%전새,치료성%초조기치료
Intracranial aneurysm%Subarachnoid hemorrhage%Embolization,therapeutic%Hyper-early treatment
目的 探讨颅内动脉瘤破裂后超早期血管内栓塞治疗的临床效果与安全性.方法 回顾性分析33例不同部位颅内动脉瘤破裂患者的临床资料,术前Hunt-Hess分级:Ⅰ～Ⅱ级16例,Ⅲ级5例,Ⅳ级9例,Ⅴ级3例.在动脉瘤破裂来院6h内气管插管全身麻醉下行电解式可脱性微弹簧圈栓塞治疗.结果 术后恢复良好25例(75.8％)；出现偏瘫和单纯运动性失语4例(12.1％),后经综合治疗1个月后逐渐恢复；死亡4例(12.1％),死亡原因:术中动脉瘤破裂出血、术后并发肺部感染、穿刺部位血肿感染、因口服“双抗”并发消化道出血.随访1～6个月,无再出血病例发生.结论 超早期血管内栓塞治疗可避免动脉瘤再次破裂出血,减轻脑血管痉挛,未增加术中动脉瘤破裂出血风险性,且超早期血管内栓塞治疗对Hunt-Hess分级Ⅳ～Ⅴ级患者可有效降低病死率.
目的 探討顱內動脈瘤破裂後超早期血管內栓塞治療的臨床效果與安全性.方法 迴顧性分析33例不同部位顱內動脈瘤破裂患者的臨床資料,術前Hunt-Hess分級:Ⅰ～Ⅱ級16例,Ⅲ級5例,Ⅳ級9例,Ⅴ級3例.在動脈瘤破裂來院6h內氣管插管全身痳醉下行電解式可脫性微彈簧圈栓塞治療.結果 術後恢複良好25例(75.8％)；齣現偏癱和單純運動性失語4例(12.1％),後經綜閤治療1箇月後逐漸恢複；死亡4例(12.1％),死亡原因:術中動脈瘤破裂齣血、術後併髮肺部感染、穿刺部位血腫感染、因口服“雙抗”併髮消化道齣血.隨訪1～6箇月,無再齣血病例髮生.結論 超早期血管內栓塞治療可避免動脈瘤再次破裂齣血,減輕腦血管痙攣,未增加術中動脈瘤破裂齣血風險性,且超早期血管內栓塞治療對Hunt-Hess分級Ⅳ～Ⅴ級患者可有效降低病死率.
목적 탐토로내동맥류파렬후초조기혈관내전새치료적림상효과여안전성.방법 회고성분석33례불동부위로내동맥류파렬환자적림상자료,술전Hunt-Hess분급:Ⅰ～Ⅱ급16례,Ⅲ급5례,Ⅳ급9례,Ⅴ급3례.재동맥류파렬래원6h내기관삽관전신마취하행전해식가탈성미탄황권전새치료.결과 술후회복량호25례(75.8％)；출현편탄화단순운동성실어4례(12.1％),후경종합치료1개월후축점회복；사망4례(12.1％),사망원인:술중동맥류파렬출혈、술후병발폐부감염、천자부위혈종감염、인구복“쌍항”병발소화도출혈.수방1～6개월,무재출혈병례발생.결론 초조기혈관내전새치료가피면동맥류재차파렬출혈,감경뇌혈관경련,미증가술중동맥류파렬출혈풍험성,차초조기혈관내전새치료대Hunt-Hess분급Ⅳ～Ⅴ급환자가유효강저병사솔.
Objective To explore the clinical efficacy and safety of hyper-early embolotherapy in treatment of intracranial ruptured aneurysm.Methods A retrospective analysis was made on 33 patients with intracranial ruptured aneurysm.Preoperative Hunt-Hess grade:grade Ⅰ-Ⅱ in 16 patients,gradeⅢin 5 patients,grade Ⅳ in 9 patients,grade Ⅴ in 3 patients.All patients were confirmed with subarachnoid hemorrhage (SAH) by angiography and then underwent embolization under general anesthesia by detachable coils within 6 h from onset.Results After operation,25 patients (75.8％) recovered well,4 patients (12.1％) were with mild disability with paralysis and aphasia,4 patients (12.1％) were dead (1 patient for intraoperative aneurysm rupture,1 patient for postoperative pneumonia,1 patient for infection of hematoma at puncture site and 1 patient for postoperative gastrointestinal bleeding).Followed up 1-6 months,no rebleeding occurred.Conclusions Hyper-early embolotherapy could avoid rebleeding of the aneurysm,and relieve the vasespasm,without increasing the intra-operative rebleeding rate.Moreover hyper-early embolotherapy could greatly decrease the mortality of poor-grade SAH patients.
