脑室穿刺术联合开颅夹闭术对脑动脉瘤破裂患者意识状态及预后的影响(1)
【摘要】目的：探讨脑室穿刺术联合开颅夹闭术对脑动脉瘤破裂患者意识状态及预后的影响。方法：选取2017年3月-2018年2月期间商丘市第一人民医院神经外二科收治的50例脑动脉瘤破裂患者作为研究对象，采用抛硬币法，正面为观察组，反面为对照组，两组个各25例。其中对照组患者采用传统脑动脉瘤开颅夹闭术治疗，观察组采用脑室穿刺术联合开颅夹闭术治疗，比较两组患者意识状态及预后。结果：术前两组患者意识状态评分对比，差异无统计学意义(P>005)；术后，观察组意识状态明显优于对照组，差异有统计学意义(P<005)；观察组预后良好占比高于对照组，差异有统计学意义(P<005)。结论：脑室穿刺术与开颅夹闭术联合治疗脑动脉瘤破裂，可有效改善患者意识状态，促进患者康复，提高其预后效果。
【关键词】 脑动脉瘤破裂；脑室穿刺术；开颅夹闭术；意识状态；预后
【中图分类号】R47374
【文献标志码】
, 百拇医药
B【文章编号】1005-0019(2018)06-001-01
Abstract Objective：To explore the effect of ventricular puncture combined with craniotomy on the state of consciousness and prognosis in patients with ruptured intracranial aneurysms.Methods： 50 cases of ruptured cerebral aneurysm treated in two families of the Shangqiu First People's Hospital in March 2017 -2018 year and February were selected as the research object， the coin method was used， the front was the observation group， the reverse was the control group， and the two groups were 25 cases each.The patients in the control group were treated with craniotomy with traditional cerebral aneurysm.The observation group was treated with ventriculocentesis combined with craniotomy， and the consciousness and prognosis of the two groups were compared.Results： there was no significant difference between the two groups before the operation (P> 005).After the operation， the conscious state of the observation group was significantly better than that of the control group (P< 005)， and the good prognosis of the observation group was higher than that of the control group， the difference was statistically significant (P< 005). Conclusion： the combined treatment of cerebral aneurysm rupture with ventriculocentesis and craniotomy can effectively improve the consciousness of the patients， promote the recovery and improve the prognosis of the patients.
, 百拇医药
Key words： Rupture of cerebral aneurysm；ventricular puncture；craniotomy；consciousness state；prognosis
腦动脉瘤破裂易导致出血性卒中，包含蛛网膜下腔出血及脑出血，若不及时治疗，易引发脑血管痉挛、癫痫发作、脑积水及低钠血症等并发症，威胁患者生命[1]。目前临床治疗该疾病多采用脑动脉瘤开颅夹闭术治疗，该治疗手段可有效降低患者颅内压，清除颅内血肿。有研究显示，运用脑室穿刺术联合开颅夹闭术治疗脑积水患者合并蛛网膜下腔出血，疗效显著[2]。基于此，本研究进一步探讨脑室穿刺术联合开颅夹闭术对脑动脉瘤破裂患者意识状态及预后的影响。具体信息如下。
1资料与方法
11一般资料选取2017年3月-2018年2月期间商丘市第一人民医院神经外二科收治的50例脑动脉瘤破裂患者作为研究对象，采用抛硬币法，正面为观察组，反面为对照组，两组个各25例。对照组中男14例，女11例；年龄46-75岁，平均年龄(5823±918)岁。观察组中男15例，女10例；年龄44-73岁，平均年龄(5723±902)岁。两组患者临床一般资料经统计学比较，差异无统计学意义(P>005)，具有可对比性。
, http://www.100md.com
12方法对照组手术方法为传统的脑动脉瘤开颅夹闭术，具体步骤如下：予以患者全身麻醉，保持仰卧位，头稍向对侧偏移，待麻醉满意后，首先对患者颅内出血程度进行严密评估，随后根据评估结果明确骨窗大小范围，予以患者翼点或翼点扩大入路，逐步分离至可见动脉瘤区，将颅内血肿清除，使得动脉瘤、载瘤动脉等得以充分显现，将瘤颈分离后，再将动脉瘤夹闭，瘤体刺破后需观察是否流出血液。若动脉瘤夹闭欠佳或瘤体体积过大，可先对瘤体进行放血处理以便达到减压的效果，待减压效果满意后，随后再次实施颅内夹闭手术。而部分患者因为瘤体未破裂动脉段膨大而可能导致无法顺利实施夹闭，则考虑采用动脉包裹骨瓣减压术进行治疗。观察组实施脑室穿刺术联合开颅夹闭术治疗：选择患者前颅底2cm与额叶外侧裂上2cm交汇直角处作为穿刺点进行穿刺，将脑脊液于侧脑室释放出来，穿刺良好的评估标准为肿胀脑组织区域塌陷较为明显，随后采取与对照组相同的颅内动脉瘤夹闭术。两组术后均采取常规治疗，如抗感染治疗、营养支持、降低颅内压、神经支持等。, http://www.100md.com(李建东)
【关键词】 脑动脉瘤破裂；脑室穿刺术；开颅夹闭术；意识状态；预后
【中图分类号】R47374
【文献标志码】
, 百拇医药
B【文章编号】1005-0019(2018)06-001-01
Abstract Objective：To explore the effect of ventricular puncture combined with craniotomy on the state of consciousness and prognosis in patients with ruptured intracranial aneurysms.Methods： 50 cases of ruptured cerebral aneurysm treated in two families of the Shangqiu First People's Hospital in March 2017 -2018 year and February were selected as the research object， the coin method was used， the front was the observation group， the reverse was the control group， and the two groups were 25 cases each.The patients in the control group were treated with craniotomy with traditional cerebral aneurysm.The observation group was treated with ventriculocentesis combined with craniotomy， and the consciousness and prognosis of the two groups were compared.Results： there was no significant difference between the two groups before the operation (P> 005).After the operation， the conscious state of the observation group was significantly better than that of the control group (P< 005)， and the good prognosis of the observation group was higher than that of the control group， the difference was statistically significant (P< 005). Conclusion： the combined treatment of cerebral aneurysm rupture with ventriculocentesis and craniotomy can effectively improve the consciousness of the patients， promote the recovery and improve the prognosis of the patients.
, 百拇医药
Key words： Rupture of cerebral aneurysm；ventricular puncture；craniotomy；consciousness state；prognosis
腦动脉瘤破裂易导致出血性卒中，包含蛛网膜下腔出血及脑出血，若不及时治疗，易引发脑血管痉挛、癫痫发作、脑积水及低钠血症等并发症，威胁患者生命[1]。目前临床治疗该疾病多采用脑动脉瘤开颅夹闭术治疗，该治疗手段可有效降低患者颅内压，清除颅内血肿。有研究显示，运用脑室穿刺术联合开颅夹闭术治疗脑积水患者合并蛛网膜下腔出血，疗效显著[2]。基于此，本研究进一步探讨脑室穿刺术联合开颅夹闭术对脑动脉瘤破裂患者意识状态及预后的影响。具体信息如下。
1资料与方法
11一般资料选取2017年3月-2018年2月期间商丘市第一人民医院神经外二科收治的50例脑动脉瘤破裂患者作为研究对象，采用抛硬币法，正面为观察组，反面为对照组，两组个各25例。对照组中男14例，女11例；年龄46-75岁，平均年龄(5823±918)岁。观察组中男15例，女10例；年龄44-73岁，平均年龄(5723±902)岁。两组患者临床一般资料经统计学比较，差异无统计学意义(P>005)，具有可对比性。
, http://www.100md.com
12方法对照组手术方法为传统的脑动脉瘤开颅夹闭术，具体步骤如下：予以患者全身麻醉，保持仰卧位，头稍向对侧偏移，待麻醉满意后，首先对患者颅内出血程度进行严密评估，随后根据评估结果明确骨窗大小范围，予以患者翼点或翼点扩大入路，逐步分离至可见动脉瘤区，将颅内血肿清除，使得动脉瘤、载瘤动脉等得以充分显现，将瘤颈分离后，再将动脉瘤夹闭，瘤体刺破后需观察是否流出血液。若动脉瘤夹闭欠佳或瘤体体积过大，可先对瘤体进行放血处理以便达到减压的效果，待减压效果满意后，随后再次实施颅内夹闭手术。而部分患者因为瘤体未破裂动脉段膨大而可能导致无法顺利实施夹闭，则考虑采用动脉包裹骨瓣减压术进行治疗。观察组实施脑室穿刺术联合开颅夹闭术治疗：选择患者前颅底2cm与额叶外侧裂上2cm交汇直角处作为穿刺点进行穿刺，将脑脊液于侧脑室释放出来，穿刺良好的评估标准为肿胀脑组织区域塌陷较为明显，随后采取与对照组相同的颅内动脉瘤夹闭术。两组术后均采取常规治疗，如抗感染治疗、营养支持、降低颅内压、神经支持等。, http://www.100md.com(李建东)