标题：老年颅内破裂动脉瘤患者不同手术时机与预后的关系

      作者：张振洲，吴昇祥，张国龙    (兰州市第一人民医院神经外科，甘肃 兰州 730050)

      卷次： 2016年27卷23期

      【摘要】 目的 探讨不同手术时机与老年颅内破裂动脉瘤患者预后的关系。方法 选择 2014年1月至2016年1月间我院神经外科收治的88例老年颅内破裂动脉瘤患者为研究对象，均给予动脉夹闭术治疗，将手术距发病时间在72 h以内的45例患者纳入早期组，手术距发病时间为4~10 d内的23例患者纳入中期组，手术距发病时间在11 d以上者20例纳入晚期组。出院时根据改良MRS量表评分对患者的预后进行评价，比较三组患者并发症发生率。结果 早期组、中期组和晚期组患者的预后良好率分别为84.44%、73.91%及80.00%，三组预后良好率比较差异无统计学意义(P>0.05)；三组患者间术中出血、术后动脉瘤再出血及脑血管痉挛发生率比较差异亦无统计学意义(P>0.05)；早期组患者术后无脑积水发生，其脑积水发生率明显低于中期组的13.04%和晚期组的10.00%，差异均有统计学意义(P<0.05)。结论 老年颅内破裂动脉瘤不同手术时机对近期预后没有明显影响，但早期手术可降低术后脑积水的发生率。
      【关键词】 老年；颅内动脉瘤；蛛网膜下腔出血；预后
      【中图分类号】 R732.2+1 【文献标识码】 A 【文章编号】 1003—6350（2016）23—3860—03

Relationship between the timing of surgery and prognosis in elderly patients with ruptured intracranialaneurysm.
ZHANG Zhen-zhou, WU Sheng-xiang, ZHANG Guo-long. Department of Neurosurgery, the First People'sHospital of Lanzhou, Lanzhou 730050, Gansu, CHINA
【Abstract】 Objective To investigate the relationship between the timing of surgery and prognosis in elderly pa-tients with ruptured intracranial aneurysm. Methods A total of 88 elderly patients with ruptured intracranial aneu-rysms, who admitted to Department of Neurosurgery of our hospital from Jan. 2014 to Jan. 2016, were selected as the re-search subjects and treated by arterial occlusion. Forty-five patients with surgical time within 72 h were divided into theearly group, and 23 patients within 4-10 d were included into the medium-term group, with 20 cases≥11 d included in-to the late group. At the time of discharge, the Modified Rankin Scale (MRS) was used to evaluate the prognosis, and theincidences of complications in three groups were compared. Results The good prognosis rate in early group, medi-um-term and late group were 84.44%, 73.91% and 80.00% respectively, and there was no significant difference amongthe three groups (P>0.05); there was no statistically significant difference in the incidence of intraoperative bleeding, re-bleeding of aneurysm and cerebral vasospasm among the three groups (P>0.05); the incidence of hydrocephalus in theearly group was significantly lower than that in the midium-term group (13.04%) and the late group (10.00%), and thedifferences were statistically significant (P<0.05). Conclusion Different surgical timing has no significant effect on theshort-term prognosis of the elderly patients with ruptured intracranial aneurysm, but early surgery can reduce the inci-dence of postoperative hydrocephalus.
      【Key words】 Elderly; Intracranial aneurysms; Subarachnoid hemorrhage; Prognosis·论 著·doi:10.3969/j.issn.1003-6350.2016.23.024