本文選題：蛛網(wǎng)膜下腔出血 + 動脈瘤　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:顱內(nèi)動脈瘤是因為局部血管異常改變形成的異樣突起,約70%的蛛網(wǎng)膜下腔出血由其引起。目前認(rèn)為腦血栓形成、高血壓腦出血和顱內(nèi)動脈瘤是形成腦血管意外的三大主要原因,顱內(nèi)動脈瘤位居第3位。動脈瘤性蛛網(wǎng)膜下腔出血(aSAH)如未得到及時、有效的治療,動脈瘤首次破裂出血會引起約15%-20%的患者死亡;2年內(nèi)的死亡率高達(dá)75%-85%;aSAH患者有幸存活下來,超過一半可能遺留偏癱、語音功能障礙等神經(jīng)損傷。目前對于aSAH患者的治療主要為血管內(nèi)治療和開顱夾閉兩種,本次研究的課題是希望在一定程度上降低患者致殘率和病死率,提高生存質(zhì)量,改善預(yù)后。本文就影響血管內(nèi)治療動脈瘤性蛛網(wǎng)膜下腔出血預(yù)后的相關(guān)因素進(jìn)行系統(tǒng)性的回顧分析和總結(jié)。方法:本文通過分析影響aSAH預(yù)后的相關(guān)因素,主要分析包括性別、年齡、有無高血壓病史、有無糖尿病病史、有無吸煙飲酒史、責(zé)任動脈瘤的部位和大小、改良Fisher分級、入院時Hunt-Hess分級、格拉斯哥生存質(zhì)量(G0S)、世界神經(jīng)外科醫(yī)師聯(lián)盟(WFNS)分級、有無血管痙攣、有無腦積水、有無再出血、有無腦缺血、有無低鈉血癥、手術(shù)方式等因素,對上述相關(guān)因素與患者3月后隨訪結(jié)果或出院時GOS分別進(jìn)行X2檢驗和t檢驗,以小于0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:患者性別、責(zé)任動脈瘤的部位、手術(shù)方式等進(jìn)行X2檢驗,分析結(jié)果顯示:上述因素與經(jīng)血管內(nèi)治療aSAH患者預(yù)后無相關(guān)性(P0.05),對患者年齡、動脈瘤最大直徑進(jìn)行t檢驗結(jié)果顯示:動脈瘤最大直徑與患者預(yù)后無相關(guān)性(P=0.699);而患者年齡與經(jīng)血管內(nèi)治療aSAH患者預(yù)后相關(guān)(P0.05)�；颊哂袩o高血壓病史、有無糖尿病病史、有無吸煙飲酒史、入院時Hunt-Hess分級、改良Fisher分級、WFNS分級、有無血管痙攣、有無腦積水、有無再出血、有無腦缺血、有無低鈉血癥等相關(guān)因素進(jìn)行X2檢驗,結(jié)果顯示:這些相關(guān)因素與經(jīng)血管內(nèi)治療aSAH患者預(yù)后的差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:目前對于動脈瘤性蛛網(wǎng)膜下腔出血的病因、病理、發(fā)病機(jī)理、治療、預(yù)后等進(jìn)行了大量的實驗研究,相關(guān)治療手段不斷完善,但其仍然是導(dǎo)致死亡和殘疾較常見的一種腦血管疾病,其"起病急驟,病情兇險,預(yù)后差"的特點決定了 aSAH必將引起神經(jīng)科醫(yī)師的足夠重視。因此,如何能有效的干預(yù)aSAH的進(jìn)展,如何有效的提高患者生存質(zhì)量,改善預(yù)后,是臨床醫(yī)生必須面對的一個嚴(yán)峻考驗,具有重要的現(xiàn)實意義。這就需要我們加強(qiáng)術(shù)前評估,選擇好的手術(shù)時機(jī)和方式,術(shù)后的護(hù)理和監(jiān)測,盡量避免手術(shù)并發(fā)癥。本研究就患者性別、年齡、有無高血壓病史、有無糖尿病病史、有無吸煙飲酒史、入院時Hunt-Hess分級、責(zé)任動脈瘤的部位和大小、改良Fisher分級、WFNS分級、有無血管痙攣、有無腦積水、有無再出血、有無腦缺血、有無低鈉血癥、手術(shù)方式、3月后隨訪結(jié)果或出院時GOS等結(jié)果進(jìn)行研究和分析,希望本次的研究結(jié)果對臨床工作(患者的監(jiān)護(hù)、管理、治療)提供一定的幫助,因此分析研究影響血管內(nèi)治療aSAH預(yù)后的相關(guān)因素具有一定的實用價值。
[Abstract]:Objective: intracranial aneurysms are caused by abnormal changes in local vascular changes. About 70% of the subarachnoid hemorrhage is caused by it. It is considered that cerebral thrombosis, hypertensive intracerebral hemorrhage and intracranial aneurysm are the three major causes of cerebral vascular accident. Intracranial aneurysms are the third. Aneurysmal subarachnoid hemorrhage (aSAH) Without timely and effective treatment, the first ruptured aneurysm of aneurysm will cause death of about 15%-20% patients; the death rate is up to 75%-85% within 2 years; aSAH patients have the privilege of surviving, more than half of them may remain hemiplegia, phonological dysfunction, and other nerve injuries. Current treatment for aSAH patients is mainly intravascular therapy and craniotomy. The subject of this study is to reduce the rate of disability and mortality, improve the quality of life and improve the prognosis to a certain extent. This paper systematically reviewed and analyzed the related factors affecting the prognosis of intravascular aneurysmal subarachnoid hemorrhage. Methods: the relevant factors affecting the prognosis of aSAH were analyzed in this paper. The main analysis included sex, age, history of hypertension, history of diabetes, the history of smoking and drinking, the location and size of the responsible aneurysm, improved Fisher classification, Hunt-Hess classification at admission, Glasgow quality of life (G0S), the world neurosurgeon Union (WFNS) classification, vasospasm, hydrocephalus, or no rebleeding There were some factors such as whether cerebral ischemia, hyponatremia, operation mode and other factors. X2 test and t test were performed on the above related factors and patients' follow-up results after March or at discharge. The difference was statistically significant with the difference of less than 0.05. Results: the sex, the location of the responsible aneurysm, the mode of operation, and so on were examined by X2 test. The results showed that the above results showed that the aforementioned causes were 0.05 There was no correlation between the prognosis and the prognosis of aSAH patients treated with intravascular treatment (P0.05). The t test of the maximum diameter of the aneurysm showed that the maximum diameter of the aneurysm was not related to the prognosis of the patients (P=0.699), and the patient's age was associated with the prognosis of the patients with aSAH (P0.05). There were no smoking and drinking history, Hunt-Hess classification at admission, improved Fisher classification, WFNS classification, no vasospasm, no cerebral hydrocephalus, no rebleeding, cerebral ischemia, or hyponatremia, and other related factors of X2 test. The results showed that the correlation factors and the prognosis of aSAH patients with intravascular treatment were statistically significant (P0.05). The etiology, pathology, pathogenesis, treatment and prognosis of aneurysmal subarachnoid hemorrhage have been studied in a large number of experiments, and the related treatment methods are constantly improved, but it is still a common cerebrovascular disease causing death and disability. The characteristics of "urgent sudden onset, dangerous condition, poor prognosis" determine that aSAH will certainly be cited. The neurologist pays much attention to it. Therefore, how to effectively intervene the progress of aSAH, how to effectively improve the quality of life and improve the prognosis is a severe test that the clinician must face, which is of great practical significance. Monitoring, as far as possible to avoid surgical complications. In this study, the patient's sex, age, history of hypertension, history of diabetes, smoking and drinking history, Hunt-Hess classification at admission, location and size of responsible aneurysm, improved Fisher classification, WFNS classification, vasospasm, hydrocephalus, no rebleeding, cerebral ischemia, or low The results of sodium hypernatremia, surgical procedure, follow-up results after March or GOS at discharge were studied and analyzed. It is hoped that the results of this study will provide some help to the clinical work (patient's monitoring, management and treatment). Therefore, it is of practical value to analyze and study the related factors that affect the prognosis of aSAH in blood vessels.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743
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本文編號：1907500