不同治療方式對高分級動脈瘤性蛛網膜下腔出血患者生存時間的影響

【中圖分類號】 R651 【文獻標志碼】 A 【文章編號】1672-7770（2025）03-0278-07

Abstract： ObjectiveTo investigate the impact treatment methods on the survival status patients with poor-grade aneurysmal subarachnoid hemorrhage.MethodsThe clinical data 376 patients with Hunt Hess grade IV- V cerebral aneurysmal subarachnoid hemorrhage in the Hospital from October 2O14 to December 2021 were analyzed retrospectively. The Kaplan Meier method was used to describe the distribution survival time and the Log-rank test was used to analyze the influence diferent treatment methods on survival time.One year after onset，the prognosis patients was evaluated with the modified Rankin scale（mRS）. ResultsAmong the 376 patients，154 patients were treated conservatively and 222 patients were surgically treated. The median survival time patients with conservative treatment was 4 days. The three-day，one-week，two-week，three-week，one-year and long-term survival rates were 66.2% ， 26.0% ， 12.3% ， 5.8% ， 1.9% and 1.3% ，correspondingly. Among 222 surgically treated patients，145 patients received micro-clipping surgery，whose median survival time was 1 296 days. The three-day，one-week，two-week， three-week，one-year and longterm survival rates were 89.0% ， 69.0% ， 62.1% ， 57.2% and 47.6% ，correspondingly. Seventyseven patients underwent interventional embolization.The three-day，one-week，two-week，threeweek，one-year and long-term survival rates were 98.7% ， 81.8% ， 71.4% ， 70.1% and 66.2% ， correspondingly. The results the Log-rank test indicated a strong correlation between treatment methods，surgical modes，and survival rates（all Plt;0.05 ）．According to the mRS scores，there were significant differences in prognosis among patients with different treatment methods（ Plt;0.01） and conservative treatment showed poorer outcomes. Similarly， significant diferences were observed in prognosis among patients with different surgical approaches，where interventional embolization demonstrated better outcomes （ Plt;0.01 ）.ConclusionsThe short-term mortality patients with poor-grade aneurysmal subarachnoid hemorrhage was high. Surgical treatment， especially interventional embolization，could significantly improve prognosis and extend the life the patients.

Key words： aneurysmal subarachnoid hemorrhage； microsurgical clipping； interventional embolization；conservative therapy；survival analysis

動脈瘤性蛛網膜下腔出血（aneurysmalsubarachnoidhemorrhage，aSAH）是第三大常見的腦卒中形式，約有 20%～40% 為高分級 aSAH^[1-3] ，其病情重，病死率高，如果不及時采取相關治療措施，死亡率為 75%～100%^[4-7] 。近年來隨著手術技術、材料及神經重癥監護治療的進步，死亡率較之前有所下降，但相較于其他類型的腦卒中，仍然較高。導致其不佳預后的因素有很多，包括動脈瘤再次破裂出血、年齡、急性腦積水、顱內出血、腦水腫、治療方式和時機等，其中治療方式是最重要的影響因素之_[8-9]。有研究表明，早期手術治療能改善高分級aSAH患者的預后，延長生存期，但目前對最佳治療方式的選擇仍存在爭議[9]。本研究回顧性分析2014年10月—2021年12月江蘇省蘇北人民醫院神經外科收治的376例Hunt-Hess分級IV-V級aSAH患者，從生存狀況的角度分析治療方式對高分級aSAH患者的影響。現報告如下。

1資料與方法

1.1一般資料共納入的376例Hunt-Hess分級 級aSAH患者，其中男154例，女222例；年齡28～80 歲，平均 （61.9±10.4） 歲；V級209例，V級167例。納入標準：（1）18＼～80歲；（2）術前或發病后早期（3d）Hunt-Hess分級 IV-V 級；（3）頭部計算機斷層掃描（computedtomography，CT）計算機斷層掃描血管造影（computed tomography angiography，CTA）或數字化減影血管造影（digitalsubtractionangiography，DSA）證實是顱內動脈瘤破裂導致的SAH；（4）責任動脈瘤為囊性動脈瘤。排除標準：（1）責任動脈瘤為血泡樣動脈瘤或梭形動脈瘤；（2）術前或發病后早期（3d）Hunt-Hess分級明顯改善且低于V級者；（3）合并心臟、肝臟、肺、腎臟等重要器官功能衰竭者；（4）早期肺部感染嚴重，需要呼吸機支持者；（5）合并煙霧病、血管畸形、顱腦外傷等顱腦疾病者。所有患者家屬均簽署知情同意書。……