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投稿时间：2019-04-29 网络发布日期：2020-03-20
投稿时间：2019-04-29 网络发布日期：2020-03-20
中文摘要: 目的 对比开颅夹闭与介入栓塞治疗急性期前交通动脉动脉瘤破裂的临床疗效及其安全性。方法 选择2015年7月至2018年6月收治的96例急性期前交通动脉动脉瘤破裂患者进行研究。采用随机数字表法将患者分为两组各48例。两组患者术前均进行脱水、降颅压、控制并发症等常规治疗,对照组行开颅夹闭术,观察组在全麻下行颅内动脉介入栓塞术。对比两组患者预后情况、神经功能、炎症相关细胞因子、氧化应激反应指标及并发症。结果 (1)术后6个月评价:观察组患者预后良好率为91.67%,明显高于对照组的72.92%，差异有统计学意义(.χ2.=5.790,P=0.0 16)。(2)术后并发症率比较:观察组并发症总发生率为12.50%,明显低于对照组的31.25%，差异有统计学意义(.χ2.=4.937,P=0.0 26)。(3)实验室指标比较:手术后,两组患者神经功能指标血髓鞘碱性蛋白（MBP）、神经元特异性烯醇化酶（NSE）及S100B蛋白（S100B）水平均下降,且观察组低于对照组，差异有统计学意义(P<0.01);两组患者炎症细胞因子基质细胞衍生因子(SDF-1A)、转化生长因子 (TGF)-β及肿瘤坏死因子(TNF)-α水平均下降,且观察组低于对照组,白细胞介素（IL）-10水平均上升,且观察组高于对照组，差异有统计学意义(P<0.01);两组患者氧化应激反应指标超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-PX）水平均升高,且观察组高于对照组,丙二醛（MDA）、脂质过氧化产物（LPO）均下降,且观察组低于对照组，差异有统计学意义(P<0.01)。结论 介入栓塞较开颅夹闭治疗可明显改善急性期前交通动脉动脉瘤破裂患者的预后且可降低并发症发生率,其作用机制可能与改善神经功能、缓解炎症反应及氧化应激反应有关。
Abstract:Objective To compare the clinical efficacy and safety of craniotomy and clipping and interventional embolization in the treatment of acute ruptured anterior communicating artery aneurysm. Methods Ninety-six patients with acute ruptured anterior communicating artery aneurysm treated from July 2015 to June 2018 were enrolled and were randomly divided into observation group and control group (n=48, each). Conventional treatment of dehydration, intracranial pressure reduction, and complication-control before operation were given in both groups. The craniotomy and clipping was performed in control group, and intracranial artery interventional embolization was conducted in observation group. The prognosis, neurological function, indicators of inflammation-related cytokines, oxidative stress response and complications were compared between two groups. Results At six months after operation, the rate with good prognosis in observation group was significantly higher than that in control group (91.67% vs 72.92%,χ2=5.790, P=0.016). The total incidence of complications in observation group was significantly lower than that in control group (12.50% vs 31.25%,χ2=4.937, P=0.026). After intervention, the levels of serum myelin basic protein (MBP), neuron specific enolase (NSE), S100B protein, stromal-derived factor-1a (SDF-1A), transforming growth factor β(TGF-β), tumor necrosis factor α(TNF-α), lipid peroxidation(LPO) and malonedialdehyde (MDA) significantly decreased in two groups and were significantly lower in observation group than those in control group (all P<0.01); the levels of IL-10, superoxide dismutase(SOD), se-dependent glutathione peroxidase (GSH-PX) increased significantly in both groups and were statistically higher in observation group than those in control group (all P<0.01). Conclusion Interventional embolization can significantly improve the prognosis of patients with acute ruptured anterior communicating artery aneurysm and reduce the incidence of complications, which may be responsible for its effect in improving neurological function, relieving inflammation and oxidative stress.
keywords: Craniotomy and clipping Interventional embolization Acute anterior communicating artery aneurysm Rupture Neurological function Inflammatory cytokines Oxidative stress
文章编号： 中图分类号： 文献标志码：A
基金项目:湖南省卫计委科研计划项目(C20180127)
引用文本：
罗忠平，陈家玉，白桂斌，邓人富，邬娜，黄斌，谭智灵，廖佐明，王荣彦.开颅夹闭与介入栓塞治疗急性期前交通动脉动脉瘤破裂的临床比较[J].中国临床研究,2020,33(3):347-351.
罗忠平，陈家玉，白桂斌，邓人富，邬娜，黄斌，谭智灵，廖佐明，王荣彦.开颅夹闭与介入栓塞治疗急性期前交通动脉动脉瘤破裂的临床比较[J].中国临床研究,2020,33(3):347-351.