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目的探讨弹簧圈瘤腔内栓塞与动脉瘤颈夹闭术治疗高分级动脉瘤性蛛网膜下腔出血(a SAH)的效果。方法选取100例世界神经外科联盟(WFNS)分级为Ⅳ~Ⅴ级的a SAH患者,经随机数字表法分为栓塞组与夹闭组各50例,栓塞组行弹簧圈瘤腔内栓塞,夹闭组行动脉瘤颈夹闭术,采用Barthel指数评价患者行为功能,比较两组近期疗效、并发症及免疫指标水平。结果两组整体预后情况无显著差异(P>0.05),栓塞组预后良好率显著高于夹闭组(P<0.05);栓塞组并发症发生率显著低于夹闭组(P<0.05);治疗后第3天,夹闭组Ig G、Ig A与Ig M水平较术前显著下降,且显著低于栓塞组(P<0.05)。治疗3个月后,两组Barthel指数明显提高,且栓塞组明显高于夹闭组(P<0.05)。结论弹簧圈瘤腔内栓塞相对动脉瘤颈夹闭术治疗高分级a SAH疗效更佳,安全性更高,对患者免疫功能影响较小,且对行为功能有所改善。
Objective To investigate the effect of coil aneurysm embolization and aneurysm neck clipping in the treatment of high grade aneurysmal subarachnoid hemorrhage (SAH). Methods A total of 100 cases of SAH classified by the World Federation of Neurosurgery (WFNS) grades Ⅳ ~ Ⅴ were enrolled in this study. They were divided into embolization group and occlusion group (n = 50) by random number table. Anesthesia was performed in the closed group. The Barthel index was used to evaluate the patient’s behavioral function. The curative effect, complications and immune indexes of the two groups were compared. Results There was no significant difference in overall prognosis between the two groups (P> 0.05). The good prognosis of the embolization group was significantly higher than that of the occlusion group (P <0.05). The incidence of complications in the embolization group was significantly lower than that in the occlusion group (P <0.05). On the third day after treatment, the levels of Ig G, Ig A and Ig M in the occlusion group were significantly lower than those before the operation, and were significantly lower than those in the embolization group (P <0.05). After 3 months of treatment, Barthel index of both groups was significantly increased, and the embolization group was significantly higher than the clamping group (P <0.05). Conclusions Embolization of annulus aneurysm is superior to saphenous artery aneurysm neck clipping in the treatment of high grade SAH. It has higher safety and less impact on the immune function of patients, and improves the behavioral function.