Hunt-Hess 2级动脉瘤急性期去骨瓣减压的临床疗效分析

发布时间：2018-04-25 07:16

本文选题：动脉瘤 + 去骨瓣减压　；参考：《吉林大学》2014年硕士论文

【摘要】：目的：探讨Hunt-Hess2级动脉瘤急性期去骨瓣减压的临床疗效。方法：选取吉林大学中日联谊医院神经外二科2012年2月-2013年8月Hunt-Hess2级动脉瘤的患者，入选标准为：CT诊断为蛛网膜下腔出血，经CTA或DSA明确出血原因为颅内动脉瘤破裂所导致。排除合并心肺等重要器官严重疾病不能耐受全麻手术的患者及选择介入栓塞的患者。均于发病后72h内行动脉瘤夹闭术，手术由同一术者完成。随机分为去骨瓣减压组和非去骨瓣减压组，术后均给予抗血管痉挛、3H疗法、抗炎等治疗。比较两组患者术后第1天、第3天、第7天GCS评分，术后二次手术率、气管切开率、缺血性神经功能障碍发生率、低钠血症发生率、迟发性脑积水发生率以及术后半年GOS预后评分的差异。结果：共有84例Hunt-Hess2级动脉瘤患者于急性期行动脉瘤夹闭术，其中去骨瓣减压组38例，非去骨瓣减压组46例。去骨瓣减压组和非去骨瓣减压组术前GCS评分、年龄、性别、动脉瘤部位和大小无统计学差异，两组病例具有可比性。去骨瓣减压组术后第1天、第3天、第7天平均GCS评分高于非去骨瓣减压组。去骨瓣减压组术后二次手术率、气管切开率、缺血性神经功能障碍发生率、低钠血症发生率明显低于非去骨瓣减压组。两组患者术后迟发性脑积水发生率无统计学差异，术后半年GOS预后评分无统计学差异。分析非去骨瓣组中经历二次手术的患者，发现其共同特征为术前CT显示蛛网膜下腔内积血较多，术中硬膜张力高，脑表颜色鲜红。结论： 1.Hunt-Hess2级动脉瘤急性期去骨瓣减压能够有效降低颅内压，有利于改善术后早期意识状态，2.去骨瓣减压能够有效降低术后二次手术率、气管切开率，早期缺血性神经功能障碍发生率、低钠血症发生率，有一定的优越性。3.急性期是否行去骨瓣减压与远期预后无关。4.对于术前CT显示蛛网膜下腔积血较多，，术中硬膜张力高，脑表颜色鲜红的患者，建议一期行去骨瓣减压。
[Abstract]:Objective: to investigate the clinical effect of decompression of bone flap in acute stage of Hunt-Hess2 grade aneurysm. Methods: The patients with Hunt-Hess2 grade aneurysm from February 2012 to August 2013 in the Department of Neurology, Sino-Japanese Friendship Hospital of Jilin University were selected and diagnosed as subarachnoid hemorrhage by CTA or DSA. It was confirmed by CTA or DSA that the cause of hemorrhage was the rupture of intracranial aneurysm. Exclusion of patients with major organ diseases such as cardiopulmonary failure to tolerate general anesthesia and choice of interventional embolization. Aneurysm clipping was performed within 72 hours after onset. The patients were randomly divided into two groups: the decompression group and the non-bone flap decompression group. All patients were treated with anti-vasospasm 3H therapy and anti-inflammatory therapy. The GCS score, the rate of secondary surgery, tracheotomy, ischemic neurological dysfunction and hyponatremia were compared between the two groups on the 1st, 3rd and 7th day after operation. The incidence of delayed hydrocephalus and the prognosis score of GOS half a year after operation. Results: A total of 84 patients with Hunt-Hess2 grade aneurysms underwent aneurysm clipping in the acute phase, including 38 cases in the osteovalvular decompression group and 46 cases in the non-boneless decompression group. There was no significant difference in preoperative GCS score, age, sex, aneurysm location and size between the two groups. The average GCS score in the decompression group was higher than that in the non-bone flap decompression group on day 1, day 3 and day 7. The rate of secondary operation, tracheotomy, ischemic neurological dysfunction and hyponatremia in the decompression group were significantly lower than those in the non-decompression group. There was no significant difference in the incidence of delayed hydrocephalus after operation between the two groups, and there was no significant difference in GOS prognostic score half a year after operation. It was found that the common features of the patients in the non-craniectomy group were that preoperative CT showed more subarachnoid hemorrhage, high dura tension during operation, and bright red on the surface of the brain. Conclusion: Decompression of bone flap in acute stage of 1.Hunt-Hess2 aneurysm can effectively reduce intracranial pressure and improve early consciousness after operation. Bone flap decompression can effectively reduce the rate of secondary surgery, tracheotomy, early ischemic neurological dysfunction, hyponatremia, has some advantages. 3. There was no correlation between decompression of bone flap in acute stage and long term prognosis. 4. 4. For the patients with subarachnoid hemorrhage, high dura tension and bright red cerebral surface, it is suggested that decompression of bone flap should be performed in one stage.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41

【参考文献】