【摘要】：目的探討高分級動(dòng)脈瘤性蛛網(wǎng)膜下腔出血的臨床特點(diǎn)及早期手術(shù)治療效果。方法回顧性分析36例Hunt-Hess分級Ⅳ、Ⅴ級動(dòng)脈瘤性蛛網(wǎng)膜下腔出血患者的臨床資料。其中,Ⅳ級28例,Ⅴ級8例;顯微手術(shù)夾閉28例,介入治療8例。采用出院時(shí)格拉斯哥預(yù)后評分(GOS)評價(jià)患者的預(yù)后。結(jié)果 2例患者術(shù)后出現(xiàn)腦積水并行腦室腹腔分流術(shù),3例出現(xiàn)肺部感染。Hunt-Hess分級Ⅳ級患者預(yù)后良好21例,預(yù)后不良7例,Ⅴ級患者預(yù)后良好3例,預(yù)后不良5例,預(yù)后良好比分別為75%(21/28)、37.5%(3/8),兩組預(yù)后比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);顯微手術(shù)夾閉治療的患者預(yù)后良好18例,預(yù)后不良10例,死亡3例;介入治療的患者預(yù)后良好6例,預(yù)后不良2例,預(yù)后良好比分別為64.29%(18/28)、75%(6/8),兩者比較預(yù)后差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論 Hunt-Hess分級Ⅳ級的患者應(yīng)根據(jù)患者綜合情況選擇合適的手術(shù)方式爭取早期手術(shù)治療,Ⅴ級患者早期手術(shù)治療效果尚有待進(jìn)一步研究。
[Abstract]:Objective to investigate the clinical characteristics and early surgical treatment of high grade aneurysm subarachnoid hemorrhage. Methods the clinical data of 36 patients with Hunt-Hess grade IV and V aneurysm subarachnoid hemorrhage were analyzed retrospectively. There were 28 cases of grade IV, 8 cases of grade V, 28 cases of microsurgical clamping and 8 cases of interventional therapy. The prognosis of the patients was evaluated by Glasgow prognosis score (GOS) at discharge. Results 2 patients had hydrocephalus complicated with intraventricular shunt and 3 patients had pulmonary infection. 21 patients with Hunt-Hess grade IV had good prognosis, 7 patients had poor prognosis, 3 patients with grade V had good prognosis and 5 patients had poor prognosis. The good prognosis ratio was 75% (21 鈮，

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