本文選題：動脈瘤 + 去骨瓣減壓�。� 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：目的：探討Hunt-Hess2級動脈瘤急性期去骨瓣減壓的臨床療效。 方法： 選取吉林大學(xué)中日聯(lián)誼醫(yī)院神經(jīng)外二科2012年2月-2013年8月Hunt-Hess2級動脈瘤的患者，入選標(biāo)準(zhǔn)為：CT診斷為蛛網(wǎng)膜下腔出血，經(jīng)CTA或DSA明確出血原因為顱內(nèi)動脈瘤破裂所導(dǎo)致。排除合并心肺等重要器官嚴(yán)重疾病不能耐受全麻手術(shù)的患者及選擇介入栓塞的患者。均于發(fā)病后72h內(nèi)行動脈瘤夾閉術(shù)，手術(shù)由同一術(shù)者完成。隨機(jī)分為去骨瓣減壓組和非去骨瓣減壓組，術(shù)后均給予抗血管痙攣、3H療法、抗炎等治療。比較兩組患者術(shù)后第1天、第3天、第7天GCS評分，術(shù)后二次手術(shù)率、氣管切開率、缺血性神經(jīng)功能障礙發(fā)生率、低鈉血癥發(fā)生率、遲發(fā)性腦積水發(fā)生率以及術(shù)后半年GOS預(yù)后評分的差異。 結(jié)果： 共有84例Hunt-Hess2級動脈瘤患者于急性期行動脈瘤夾閉術(shù)，其中去骨瓣減壓組38例，非去骨瓣減壓組46例。去骨瓣減壓組和非去骨瓣減壓組術(shù)前GCS評分、年齡、性別、動脈瘤部位和大小無統(tǒng)計學(xué)差異，兩組病例具有可比性。去骨瓣減壓組術(shù)后第1天、第3天、第7天平均GCS評分高于非去骨瓣減壓組。去骨瓣減壓組術(shù)后二次手術(shù)率、氣管切開率、缺血性神經(jīng)功能障礙發(fā)生率、低鈉血癥發(fā)生率明顯低于非去骨瓣減壓組。兩組患者術(shù)后遲發(fā)性腦積水發(fā)生率無統(tǒng)計學(xué)差異，術(shù)后半年GOS預(yù)后評分無統(tǒng)計學(xué)差異。分析非去骨瓣組中經(jīng)歷二次手術(shù)的患者，發(fā)現(xiàn)其共同特征為術(shù)前CT顯示蛛網(wǎng)膜下腔內(nèi)積血較多，術(shù)中硬膜張力高，腦表顏色鮮紅。 結(jié)論： 1.Hunt-Hess2級動脈瘤急性期去骨瓣減壓能夠有效降低顱內(nèi)壓，有利于改善術(shù)后早期意識狀態(tài)，2.去骨瓣減壓能夠有效降低術(shù)后二次手術(shù)率、氣管切開率，早期缺血性神經(jīng)功能障礙發(fā)生率、低鈉血癥發(fā)生率，有一定的優(yōu)越性。3.急性期是否行去骨瓣減壓與遠(yuǎn)期預(yù)后無關(guān)。4.對于術(shù)前CT顯示蛛網(wǎng)膜下腔積血較多，，術(shù)中硬膜張力高，腦表顏色鮮紅的患者，建議一期行去骨瓣減壓。
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.41

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