CAJ | 학술논문

目的探讨Hunt‐Hess Ⅳ～Ⅴ级动脉瘤的手术治疗方法和时机。方法回顾性分析我科2006‐01—2013‐06收治的117例Hunt‐HessⅣ～Ⅴ级动脉瘤，其中Ⅳ级96例，Ⅴ级21例。本组病例均在蛛网膜下腔出血24～48 h内手术治疗，动脉瘤夹闭103例，夹闭加包裹14例，去骨瓣减压19例，侧脑室开放引流13例。结果按GOS标准评分，Ⅳ级96例中5分23例，4分28例，3分33例，2分和1分12例。Ⅴ级21例中4分1例，3分5例，2分和1分15例。结论对于 Hunt‐Hess Ⅳ级患者要在蛛网膜下腔出血早期（1～2 d）手术干预，Ⅴ级伴较大血肿或脑室大量积血积水患者建议早期手术，同时去骨瓣减压或脑室引流。
목적탐토Hunt‐Hess Ⅳ～Ⅴ급동맥류적수술치료방법화시궤。방법회고성분석아과2006‐01—2013‐06수치적117례Hunt‐HessⅣ～Ⅴ급동맥류，기중Ⅳ급96례，Ⅴ급21례。본조병례균재주망막하강출혈24～48 h내수술치료，동맥류협폐103례，협폐가포과14례，거골판감압19례，측뇌실개방인류13례。결과안GOS표준평분，Ⅳ급96례중5분23례，4분28례，3분33례，2분화1분12례。Ⅴ급21례중4분1례，3분5례，2분화1분15례。결론대우 Hunt‐Hess Ⅳ급환자요재주망막하강출혈조기（1～2 d）수술간예，Ⅴ급반교대혈종혹뇌실대량적혈적수환자건의조기수술，동시거골판감압혹뇌실인류。
Objective To explore the method and timing for Hunt‐Hess grade Ⅳ‐Ⅴ intracranial aneurysms. Methods The clinical data of 117 cases Hunt‐Hess grade Ⅳ‐Ⅴ aneurysms admitted to our department from January 2006 to June 2013 were analyzed retrospectively ,among which 96 cases Hunt‐Hess grade Ⅳ ,21 cases grade Ⅴ. All of them were surgically trea‐ted within 24‐48 hours after aneurysm ruptured of which 103 cases clipped and 14 cases clipped plus wrapped.Results The prognosis was assessed by Glasgow outcome scale(GOS) ,96 cases grade Ⅳ achieved 5 score 23 cases ,4 score 28 cases ,3 score 33 cases ,2and1 score 12 cases. 21 cases grade Ⅴ achieved 4 score 1case ,3 score 5 cases ,2and1 score 15 cases.Conclusion It is better for Hunt‐Hess grade Ⅳ patients be treated surgically within 1‐2 days after aneurysms ruptured. Surgical treatment is not recommended for Hunt‐Hess grade Ⅴ patients unless there is giant haematoma or acute hydrocephalus.