Influence of the timing of microsurgical clipping on the prognosis of patients with poor-grade aneurysmal subarachnoid hemorrhage
11.3969/j.issn.1672-5921.2015.07.004
- VernacularTitle:显微夹闭手术时机对高分级动脉瘤性蛛网膜下腔出血患者预后的影响
- Author:
Bingwei SONG
;
Yong ZHEN
;
Liang HE
;
Linhai SHEN
;
Nan ZHANG
- Publication Type:Journal Article
- Keywords:
Intracranial aneurysm;
Subarachnoid hemorrhage;
Poor-grade aneurysm;
Operation timing
- From:
Chinese Journal of Cerebrovascular Diseases
2015;(7):352-355,379
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the influence of different timing of surgery on patients with poor-grade intracranial aneurysm. Methods The clinical data of 86 patients with aneurysmal subarachnoid hemorrhage (Hunt-Hess gradeⅣ toⅤ)were analyzed retrospectively. The patients were divided into an ultra-early treatment group (the operative time within 24 h after onset;n=40),an early treatment group, (24 to 72 h after onset;n=27),and middle and late treatment group (>72 h after onset;n=19)according to the different timing of surgery. The prognosis of patients at 6 months after procedure was evaluated with the modified Rankin Scale (mRS)scores. The differences of the rate of good prognosis (mRS 0 to 2)and mortality in patients of the 3 groups were compared. Results (1 )The ratios of good prognosis in the ultra-early treatment group,early treatment group,and middle and late treatment group were 55. 0%(n=22),33. 3%(n=9),and 21. 1%(n=4),respectively. There were significant differences (P<0. 05). The mortality rate of the ultra-early treatment group (7. 5%)was lower than that of the early treatment group (25. 9%) or middle and late treatment group (42. 1%). There were significant differences (P<0. 05). (2)There were significant differences in the rate of good prognosis in different timing of surgery in patients with gradeⅣ(P<0. 05);there was no significant difference in the rate of good prognosis in patients with grade Ⅴ(P>0. 05). The mortality ratios in patients of the 3 groups were 2/18,4/11,and 6/11,respectively. There were significant differences (P<0. 05). Conclusion Ultra-early operation may benefit part of the patients with poor-grade aneurysm,particularly in patients with gradeⅣ. As for the patients with grade Ⅴ, ultra-early operation may help to reduce short-term mortality rate,however,the rate of vegetative state is high.
