南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (09): 1353-1358.doi: 10.12122/j.issn.1673-4254.2020.09.20

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云南地区动脉瘤性蛛网膜下腔出血手术患者的长期结局分析

孙 杰，王泽易，苏 平，刘 俊，李俊彦，马 钢，岑键昌，常 谦，刘兴海，赵 楠   

  • 出版日期:2020-09-20 发布日期:2020-09-20

Long-term clinical outcomes of patients with aneurysmal subarachnoid hemorrhage in Yunnan Province

  • Online:2020-09-20 Published:2020-09-20

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摘要： 目的 为云南地区动脉瘤性蛛网膜下腔出血（aSAH）手术患者的长期临床结局提供真实数据支撑。方法 回顾性分析85例aSAH手术患者，记录他们的人口学特征、血管危险因素、入院时的病情严重程度和动脉瘤的位置。采用改良Rankin量表（mRS）和ADL量表评价两种手术方式后患者的临床结局和生活能力。结果 34例（40.0%）行开颅夹闭，51例（60.0%）行血管内栓塞治疗。经过中位数66.23个月（IOR为12.03个月）的随访，84.7%的患者mRS评分较低，78.8%的患者能独立生活。入院时患者的WFNS分级，分别与随访时mRS评分（95% CI=1.48-19.09，P=0.011）和ADL评分（95% CI=2.55-28.77，P<0.001）显著相关。多变量分析显示，年龄（95% CI=1.02-1.23，P=0.017；95% CI=1.00-1.15，P=0.038）和入院时高WFNS分级（95%CI=2.19-141.48，P=0.007；95% CI=2.84-82.61，P=0.002）是随访时mRS评分和ADL评分的独立预测因子。两种手术方式的长期结果和住院时间无显著差异（P>0.05），但住院费用血管内栓塞组明显高于开颅夹闭组（P<0.001）。结论 在云南地区的这组患者中，老龄和入院时高WFNS分级都容易导致临床结局不良；开颅夹闭或血管内栓塞在长期治疗效果方面没有优劣；从卫生经济学的角度，高WFNS分级的患者更适合开颅夹闭。

关键词: 动脉瘤性蛛网膜下腔出血, 开颅夹闭, 血管内弹簧圈栓塞, 长期临床结局

Abstract: Objective To investigate the clinical outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) after surgeries in Yunnan Province. Methods We retrospectively analyzed the demographic features, vascular risk factors, severity at admission, and aneurysm locations in 85 patients with aSAH receiving surgical interventions in Yunnan Province. All the patients were treated by aneurysm clipping or coiling and followed up for clinical outcomes and recovery of daily activities evaluated by modified Rankin Scale (mRS) and Activities of Daily Living (ADL) scale, respectively. Results Thirty-four of the patients (40.0% ) underwent aneurysm clipping and 51 (60.0% ) underwent aneurysm coiling. During a median follow- up period of 66.23 months (IOR, 12.03 months), 84.7% of the patients had low mRS scores, and 78.8% lived independently. The WFNS grade at admission was significantly correlated with the follow-up mRS scores (95%CI: 1.48-19.09, P=0.011) and ADL (95%CI: 2.55-28.77, P<0.001). Multivariate analysis showed that age (95%CI: 1.02-1.23, P=0.017; 95%CI: 1.00-1.15, P=0.038) and a high WFNS grade at admission (95%CI: 2.19-141.48, P=0.007; 95%CI: 2.84-82.61, P=0.002) were independent predictors of both mRS and ADL scores at follow-up. There was no significant difference in clinical outcomes or the length of hospital stay between the two treatment strategies (P>0.05), but the cost of hospitalization was significantly higher in coiling group than in the clipping group (P<0.001). Conclusions Both aging and a high WFNS grade at admission are associated with a poor prognosis of aSAH, for which aneurysm clipping and coiling have similar long-term outcomes, but for patients with a high WFNS score, aneurysm clipping is favored over coiling in terms of health economics.

Key words: aneurysmal subarachnoid hemorrhage, surgical clipping, endovascular coiling, long-term clinical outcomes