【摘要】 目的 探讨颅内动脉瘤破裂的手术适宜时机。方法 回顾性分析440例颅内动脉瘤破裂患者临床资料。按术前Hunt-Hess分级,分为A组(Hunt-HessⅠ～Ⅱ级,n=310)、B组(Hunt-HessⅢ级,n=74)和C组(Hunt-HessⅣ～Ⅴ级,n=56);按手术时机分为早期手术组(≤3天,n=181)、间期手术组(4～10天,n=116)、晚期手术组(≥11天,n=143)。用格拉斯哥转归量表(Glasgow Outcome Scale,GOS)评价转归。结果 A组和C组患者不同手术时机与预后转归比较无统计学差异,A组(χ~2=0.918,P=0.632),C组(χ~2=4.889,P=0.087);B组患者早期手术良好率明显高于非早期手术(χ~2=6.161,P=0.046)。结论 Hunt-HessⅠ～Ⅱ级患者各期手术均可以,Hunt-HessⅢ级患者宜早期手术,Hunt-HessⅣ～Ⅳ级患者虽总体预后不良仍应尽早手术。更多还原

【Abstract】 Objective To investigate the appropriate surgical timing of ruptured intracranial aneurysms.Methods To retrospectively analyze 440 cases of ruptured intracranial aneurysm,the 440 patients were divided into group A(grades Ⅰ to Ⅱ,n=310),group B(grade Ⅲ,n=74) and group C(grades Ⅳ to Ⅴ) according to Hunt-Hess grade of patients’ preoperative physical status.In the meantime,these patients were divided into early surgery group(≤3 d,n=181),intermediate surgery group(4-10 d,n=116),and late surgery group(≥11 d,n=143) based on the surgical timing.And evaluate these patients’ outcome by Glasgow Outcome Scale(GOS).Results In patients of group A(χ~2=0.918,P=0.632) and group C(χ~2=4.889,P=0.087).There was no statistically difference in different surgical timing and outcome.In patients of Group B,the rate of good outcomes was significantly higher in early surgery patients than that in non-early surgery patients.By Kruskal-Wallis test(χ~2=6.161,P=0.046).Conclusions Time of surgery does not matter in patients of Hunt-Hess grades Ⅰ to Ⅱ.In patients of grade Hunt-Hess Ⅲ,early operation should be taken.Though poor overall prognosis of patients of Hunt-Hess Ⅳ to Ⅴ grades,early operation also should be taken.更多还原