【摘要】 目的　分析 75岁以上老年人脑动脉瘤破裂的手术治疗价值。　方法　回顾性分析 75岁以上老年人脑动脉瘤破裂 2 2例中 1 1例行显微外科手术治疗的结果。　结果　 2 2例中 ,H &K ～ 级 1 0例 ,死亡 6例 ; ～ 级 1 2例 ,死亡 3例。早期手术的 1 1例中 ,术后恢复良好 4例 ,死亡 1例 ,病死率 9.1 %。其中 H &K ～ 级 5例 ,预后良好 2例、中残 2例、死亡 1例 ; ～ 级 6例 ,良好 2例、中残 2例、植物人生存 2例。总良好率 3 6.4 %。 1 1例非手术患者死亡 8例 ,病死率 72 .7%。　结论　术前临床分级及全身性疾病与患者预后密切相关。对 H &K ～ 级的 75岁以上老年脑动脉瘤破裂患者 ,早期直接显微手术夹闭脑动脉瘤是治疗脑动脉瘤破裂的首选方法 ,H &K ～ 级前循环脑动脉瘤破裂的患者只要不伴有严重的全身性疾病 ,手术治疗仍是挽救生命甚至达到良好恢复的方法。更多还原

【Abstract】 Objective To investigate the outcome and expound the role of the surgical treatment for patients aged over 75 years with ruptured intracranial aneurysms. Methods The history of patients with ruptured aneurysms admitted in this hospital from October 1990 to March 1997 was reviewed. Eleven patients (50%) received operation. To analyze the relationship between the outcome and clinical grading scale of H & K, Fisher’s grading by CT and history of systemic diseases. Meanwhile, surgical outcome and the relative risk factors were discussed. Results The clinical grading scale of H & K and Fisher’s grading by CT were correlated with the outcome in those patients. In the 22 patients with ruptured aneurysms, there were 10 patients with H & K grade Ⅳ Ⅴ on admission, six of them died. Among the 12 patients with H & K grade Ⅰ Ⅲ on admission, three died. Eleven patients underwent operation in early stage, operative mortality and good recovery rate were 9 1% and 36 4% respectively, but the outcome of unoperated patients was very poor with mortality of 72 7%. Conclusions Preoperative clinical condition and past history were related to outcome. Direct early surgery should be considered an useful therapy for patients aged over 75 years in group Ⅰ Ⅲ of H & K. Operation can even be considered in patients with group Ⅳ Ⅴ with the aneurysm at anterior portion of the brain circulation, but without a history of severe systemic disease.更多还原