本文關(guān)鍵詞： 顱內(nèi)動(dòng)脈瘤 蛛網(wǎng)膜下腔出血 動(dòng)脈瘤夾閉 回顧性分析　出處：《昆明醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：顱內(nèi)動(dòng)脈瘤(intracranial aneurysm)系顱內(nèi)動(dòng)脈血管由于一系列因素作用所致血管壁的異常突起。動(dòng)脈瘤好發(fā)年齡一般為40-60歲,女性略高于男性,是目前腦血管疾病中致死、致殘率最高的疾��；其中前交通動(dòng)脈瘤(ACoAA)發(fā)病率最高約30%；故臨床工作中做到對(duì)動(dòng)脈瘤的早期診斷、早期處理變得至關(guān)重要。目的：評(píng)估傳統(tǒng)開顱手術(shù)治療顱內(nèi)動(dòng)脈瘤的療效、并發(fā)癥及影響預(yù)后的相關(guān)因素進(jìn)行評(píng)估、分析。方法：收集42例于2012年9月至2015年1月在云南省第一人民醫(yī)院神經(jīng)外科根據(jù)影像學(xué)資料以“前交通動(dòng)脈瘤”收治住院的顱內(nèi)動(dòng)脈瘤患者,且行傳統(tǒng)開顱動(dòng)脈瘤夾閉術(shù)的患者的治療過程資料作回顧性分析。通過改良Rankin量表評(píng)分、本院影像學(xué)資料復(fù)查情況、有無動(dòng)脈瘤再出血情況、術(shù)后并發(fā)癥.發(fā)病年齡等來評(píng)估開顱手術(shù)夾閉顱內(nèi)動(dòng)脈瘤的治療效果,并對(duì)統(tǒng)計(jì)數(shù)據(jù)進(jìn)行spss軟件x2檢驗(yàn)分析。結(jié)果：所有42例患者出院時(shí),運(yùn)用改良Rankin量表來進(jìn)行預(yù)后比較,預(yù)后良好評(píng)分0-2分,預(yù)后不良評(píng)分3-5分或死亡。運(yùn)用統(tǒng)計(jì)學(xué)分析提示入院時(shí)Hunt- Hess分級(jí)對(duì)預(yù)后的影響P值0.05(P=0.017)、術(shù)前動(dòng)脈瘤有無破裂對(duì)預(yù)后的影響P值0.05(P=0.048),術(shù)中動(dòng)脈瘤有無破裂對(duì)預(yù)后的影響P值0.05(P=0.039),術(shù)后并發(fā)腦血管痙攣及術(shù)后并發(fā)癥對(duì)患者預(yù)后的影響P值0.05(P=0.025),年齡對(duì)患者術(shù)后預(yù)后的影響P值0.05(P=0.801)。結(jié)論：臨床工作中動(dòng)脈瘤患者早期手術(shù)的總體預(yù)后趨勢(shì)較晚期手術(shù)好；對(duì)早期手術(shù)組的動(dòng)脈瘤患者在進(jìn)行亞分組分析得出在發(fā)生SAH后24～48小時(shí)內(nèi)進(jìn)行手術(shù)的患者預(yù)后較24小時(shí)內(nèi)的患者和48-72小時(shí)內(nèi)的患者總體預(yù)后好；動(dòng)脈瘤患者在發(fā)生SAH入院后在血管痙攣期(6-10天)內(nèi)進(jìn)行手術(shù)的患者總體預(yù)后效果較早期手術(shù)和晚期手術(shù)差;入院時(shí)未破裂動(dòng)脈瘤患者較動(dòng)脈瘤破裂的患者總體手術(shù)效果和預(yù)后效果好；術(shù)中動(dòng)脈瘤未破裂的患者較術(shù)中動(dòng)脈瘤破裂的患者總體預(yù)后好；術(shù)后無嚴(yán)重并發(fā)癥的患者較有嚴(yán)重并發(fā)癥的患者總體預(yù)后好,年齡60歲者與年齡60歲者術(shù)后總體預(yù)后無統(tǒng)計(jì)學(xué)差異。
[Abstract]:Intracranial aneurysm is the abnormal protuberance of the wall of intracranial artery caused by a series of factors. The common age of aneurysm is 40-60 years old, the female is slightly higher than the male, which is the disease with the highest rate of disability and death among cerebrovascular diseases. ACoAAA has the highest incidence of ACoAAs, so it is very important to make early diagnosis and early management of aneurysms in clinical work. Objective: to evaluate the curative effect of traditional craniotomy on intracranial aneurysms. Complications and prognostic factors were evaluated. Methods: from September 2012 to January 2015, 42 patients with intracranial aneurysms admitted to the Department of Neurosurgery in the first people's Hospital of Yunnan Province were treated with anterior communicating aneurysm according to the imaging data. The data of the treatment process of the patients undergoing traditional intracranial aneurysm clipping were retrospectively analyzed. By using the modified Rankin scale, the imaging data of our hospital were re-examined, and whether the aneurysm rebleeding was found. Postoperative complications, age of onset, etc., were used to evaluate the therapeutic effect of clipping intracranial aneurysms after craniotomy, and the statistical data were analyzed by spss software x2. Results: all 42 patients were discharged from hospital, and the prognosis was compared with modified Rankin scale. Prognostic score 0-2, Statistical analysis was used to indicate the influence of Hunt- Hess grading on prognosis on admission (P = 0.05) and the influence of preoperative rupture of aneurysm on prognosis (P = 0.05) and the effect of aneurysm rupture during operation on prognosis. P value was 0.05%, P value was 0.05%, P value was 0.05%, P value was 0.05%, P value was 0.05%, P value was 0.05%, P value was 0.05%, P value was 0.05%, P value was 0.05%, P value was 0.05%. Conclusion: the general prognosis of patients with aneurysm in clinical work is better than that of late operation. The subgroup analysis of aneurysms in the early operative group showed that the prognosis of the patients who underwent the operation within 24 hours after the onset of SAH was better than that of the patients within 24 hours and 48 to 72 hours after the onset of SAH, and the overall prognosis of the patients was better than that of the patients within the first 24 hours and 48 to 72 hours. The overall prognosis of patients with aneurysm undergoing angiospasm within 6-10 days after the onset of SAH was worse than that of early and late surgery. Patients with unruptured aneurysms at admission had better overall operative effect and prognosis than patients with ruptured aneurysms, patients with unruptured aneurysms had better overall prognosis than patients with ruptured aneurysms during operation. The overall prognosis of patients without severe complications was better than that of patients with severe complications. There was no significant difference in the overall prognosis between 60 years old and 60 years old.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 趙繼宗,李京生,王碩,隋大立,孟國(guó)路,劉巍,孫建軍;顱內(nèi)動(dòng)脈瘤1041例顯微手術(shù)治療臨床研究[J];中華醫(yī)學(xué)雜志;2003年01期

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本文編號(hào)：1545789