【摘要】 目的评价血管内治疗高级别(Hunt-Hess Ⅳ～Ⅴ级)的急性动脉瘤性蛛网膜下腔出血(aSAH)的早期疗效和长期随访结果。方法选取2001年1月—2009年12月行血管内栓塞治疗的44例高级别aSAH患者,进行回顾性分析。其中37例为Hunt-HessⅣ级,7例为Hunt-Hess Ⅴ级。对术中、术后并发症、出院时临床预后(mRS评分)及平均12.4个月的长期随访结果进行综合评价。结果①44例中,39例动脉瘤完全闭塞,2例动脉瘤栓塞率≥90%,3例动脉瘤栓塞率为70%～90%。②3例(6.8%)出现术中并发症,其中2例为动脉瘤破裂出血,1例术中弹簧圈脱出。③术后14d连续行TCD监测,显示26例出现严重血管痉挛,其中11例死亡。④出院时,15例(34.1%)死亡,29例(65.9%)存活,其中2例(4.5%)预后良好,27例(61.4%)均残留有中、重度的神经功能障碍,27例中24例(24/37,64.9%)为Hunt-Hess Ⅳ级患者,3例(3/7)为Ⅴ级患者,两组比较预后差异无统计学意义。⑤29例存活患者中,27例获得长期随访,平均随访时间为38个月(6～71个月)。27例中,18例(66.7%)预后良好,6例(22.2%)遗留有中、重度残疾,3例(11.1%)出院后死亡。长期预后良好率、病死率均为42.96%(18/42)。27例中,20例行影像学复查,均未见动脉瘤复发。结论对高级别aSAH患者,血管内治疗的有效性仍有待于进一步研究。更多还原

【Abstract】 Objective To assess the early efficacy and long-term results of the patients with high-grade (Hunt-Hess Ⅳ-Ⅴ) acute aneurysmal subarachnoid hemorrhage (aSAH) treated by endovascular methods.Methods Forty-four patients with high-grade aSAH (37 with Hunt-Hess grade Ⅳ and 7 with Hunt-Hess grade Ⅴ) diagnosed and treated from January 2001 to December 2009 were analyzed retrospectively. A comprehensive evaluation was performed for the complications of treatment , the clinical condition at discharge, and the long-term (mean 12.4 months) follow-up results of the patients.Results ①In the 44 patients, the aneurysms of 39 patients were obliterated completely.The obliterate degree was >90% in 2 cases and 70% -90% in 3 cases .②Three cases (6.8%) had intraoperative complications, two of them had aneurysm rupture, and one had protruding of coil.③The postoperative continuous TCD monitoring for 14 days showed that 26 patients had severe vasospasm, and 11 of them died.④Final results, 15 patients (34.1%) died; 29 (65.9%) survived, two of them (4.5%) had good prognosis, 27 (61.4%) were left with moderate to severe neurological dysfunction, 24 of the 27 patients were in the Hunt-Hess Ⅳ and 3 were in the Hunt-Hess Ⅴ grading after aSAH.⑤Among the 29 survivors, 27 obtained long-term follow -up data, and the mean follow-up period was 38 months (range, 6 to 71).Of the 27 patients, 18 (66.7%) had good prognosis, 6 (22.2%) left with moderate to severe disability, and 3 (11.1%) died after discharge.Both the long-term good prognosis rate and mortality rates were all 42.86% (18/42). Twenty of the 27 patients were reexamined, no recurrence of aneurysm was found.Conclusion The effectiveness of endovascular treatment remains to be further studied for patients with high-grade aSAH.更多还原