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目的 对于蛛网膜下腔出血H&HⅣ级和Ⅴ级动脉瘤患者的治疗时机和方法一直是有争论的。很多文献报告手术治疗改进了临床预后、降低了病死率。也有很多H&HⅣ级和Ⅴ级动脉瘤患者被排除在治疗外。目前动脉瘤的血管内治疗日益增多 ,本文探讨H&HⅣ级和Ⅴ级动脉瘤患者的超早期电解可脱弹簧圈栓塞治疗方法和评估疗效。方法 H&HⅣ级和Ⅴ级的动脉瘤患者 2 6例 ,共 2 8个动脉瘤。动脉瘤破裂后 2 4h内行超选GDC或EDC栓塞 ,有脑室铸形或脑积水栓塞后行脑室外引流 9例 ,3例行开颅单纯去骨瓣减压术 ,术后“三高”治疗。结果 H&HⅣ级 18例 ,占 6 9.2 % ;H&HⅤ级 8例 ,占 30 .8%。动脉瘤完全栓塞 10 0 %为 18枚 (6 4 .3% )。术后GOSⅠ级和Ⅱ级 14例 (6 1.1%Ⅳ级 11例 ,Ⅴ级 3例 37.5 % )占 5 3.8% ,2例严重神经功障碍 ,死亡 10例 (38.5 % )。随访 2个月～ 4年 ,无动脉瘤再出血。结论 H&HⅣ级和Ⅴ级动脉瘤患者虽然临床状况差 ,血管痉挛发生率高 ,但超早期通常都能顺利进行动脉瘤的栓塞治疗 ,辅助行脑室外引流等微侵袭治疗方法。虽然仍有较高的致残和病死率 ,但多数患者取得了满意的疗效。
Aims The timing and method of treatment for H & H grade IV and V aneurysms in patients with subarachnoid hemorrhage have been debated. Many literatures report that surgical treatment improves clinical outcomes and reduces mortality. There are many patients with H & H grade IV and V aneurysms that are excluded from treatment. Currently aneurysm endovascular treatment is increasing, this article discusses the H & H class and V aneurysm patients with ultra-early electrolytic depolarization coil embolization treatment and evaluation of curative effect. Methods Twenty-six aneurysms with H & H grade IV and V aneurysms were enrolled. A total of 28 aneurysms were included. Aortic aneurysm rupture within 24 hours after the election of GDC or EDC embolization, intraventricular cast or hydrocephalus ventricular drainage after drainage in 9 cases, 3 cases of craniotomy decompressive craniectomy, postoperative “three high” treatment. Results H & H Ⅳ grade 18 cases, accounting for 62.2%; H & H Ⅴ grade 8 cases, accounting for 30.8%. Complete embolization of aneurysms was 10 0% (18.4%). The postoperative GOS Ⅰ and Ⅱ grade 14 cases (6 1.1% Ⅳ grade 11 cases, Ⅴ grade 3 37.5%) accounted for 5 3.8%, 2 cases of severe neurological dysfunction, death in 10 cases (38.5%). Follow-up 2 months to 4 years, no aneurysm rebleeding. Conclusion Although H & H grade ¢ ô and Ⅴ aneurysms have poor clinical status and high incidence of vasospasm, ultrathin embolization of aneurysms is usually performed in the early stage, and microinvasive treatment such as ventricular drainage is assisted. Although there are still high levels of disability and mortality, most patients have achieved satisfactory results.