早期介入栓塞治疗动脉瘤性蛛网膜下腔出血的优势及术后认知功能障碍影响因素分析

doi:10.19854/j.cnki.1008-2425.2023.05.0007

摘要/Abstract

摘要： 目的分析早期介入栓塞治疗动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)的优势及术后认知功能障碍的影响因素。方法选取aSAH患者100例,依据治疗方式分为介入组(早期介入栓塞,75例)、开颅组(开颅夹闭,25例),对比两组疗效、免疫功能、血压、蒙特利尔认知评估量表(montreal cognitive assessment,MoCA)评分,并依据MoCA评分将介入组分为认知障碍组、正常组,分析影响术后认知功能障碍的因素。结果介入组总有效率高于开颅组(P＜0.05);术后1周免疫球蛋白A(Immunoglobulin A,IgA)、免疫球蛋白M(Immunoglobulin M,IgM)、脑脊液乳酸清除率水平高于开颅组,收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)低于开颅组(P＜0.05);术后1周、3个月介入组MoCA评分高于开颅组,术后3个月认知障碍、并发症发生率均低于开颅组(P＜0.05);Logistics回归分析显示年龄、动脉瘤直径、Hunt-Hess分级、脑脊液乳酸清除率、Fisher分级为早期介入栓塞治疗aSAH后认知功能障碍的影响因素(P＜0.05)。结论早期介入栓塞治疗aSAH较开颅夹闭术后认知障碍发生率低,年龄高、动脉瘤直径大、脑脊液乳酸清除率低、Hunt-Hess及Fisher高分级患者易出现认知功能障碍,在术后随访中需早期识别并加强干预。

关键词: 早期, 介入栓塞, 动脉瘤性蛛网膜下腔出血, 认知功能障碍, 影响因素

Abstract: Objective To analyze the advantages of early interventional embolization in the treatment of aneurysmal subarachnoid hemorrhage (aSAH) and the influencing factors of postoperative cognitive dysfunction.Methods According to different treatment methods,100 patients with aSAH were divided into intervention group (early interventional embolization,75 cases) and craniotomy group (craniotomy clipping,25 cases).Curative effect,immune function,blood pressure and the Montreal cognitive assessment scale (MoCA) scores were compared between groups.Then,patients in the interventiongroup were divided into cognitive disordergroup and normal group.The factors influencing postoperative cognitive dysfunction were analyzed.Results The total response rate in intervention group was higher than that in craniotomy group (P＜0.05).A week after surgery,Immunoglobulin A (IgA),Immunoglobulin M (IgM) andlactate clearance rate levels in interventiongroup were higher than those in craniotomy group.Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lower than those in craniotomy group (P＜0.05).The MoCA scores of intervention group at 1 week and 3 months after surgerywere higher than those of craniotomy group.The incidence rates of cognitive impairment and complications in 3 months after surgery were lower than those in craniotomy group(P＜0.05).Logistic regression analysis found that age,aneurysm diameter,Hunt-Hess grading,lactate clearance rate and Fisher grading were influencing factors of cognitive dysfunction after early interventional embolization for aSAH (P＜0.05).Conclusion Compared with craniotomy clipping,the incidence of postoperative cognitive dysfunction is lower after early interventional embolization.Patients of advanced age,with large aneurysmdiameter,low cerebrospinal fluid lactate clearance rate,high Hunt-Hess and Fishergrades are prone to cognitive dysfunction.Therefore,early recognition and enhanced intervention are needed during follow-up after surgery.

Key words: Early, Interventional embolization, Aneurysmal subarachnoid hemorrhage, Cognitive dysfunction, Influencing factor

中图分类号:

R743.35

朱海波, 马晓龙, 张勇, 韩羽凤. 早期介入栓塞治疗动脉瘤性蛛网膜下腔出血的优势及术后认知功能障碍影响因素分析[J]. 立体定向和功能性神经外科杂志, 2023, 36(5): 293-298.

Zhu Haibo, Ma Xiaolong, Zhang Yong, et al. Advantages of early interventional embolization in the treatment of aneurysmal subarachnoid hemorrhage and the influencing factors of postoperativecognitive dysfunction[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2023, 36(5): 293-298.

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