Effect of early operation for ruptured aneurysms on prevention of delayed ischemic symptoms.
Effect of early operation for ruptured aneurysms on prevention of delayed ischemic symptoms.
复制标题
破裂动脉瘤早期手术对预防迟发性缺血症状的影响。
DOI：
10.3171/jns.1982.57.5.0622
复制
发表时间：
1982
影响因子：
4.1
通讯作者：
Mamoru Taneda
中科院分区：
文献类型：
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作者：
Mamoru Taneda
在连续239例幕上非巨大动脉瘤破裂患者中评价了蛛网膜下腔血凝块清除对预防迟发性缺血性功能障碍的作用。所有患者均在蛛网膜下腔出血（SAH）后24小时内住院，根据Hunt和Hess系统将其分为1 ~ 4级;在SAH后48小时内手术的患者术前立即进行分类，或计划延迟手术的患者在SAH后48小时进行分类。44例计划延迟手术10天或更长时间的患者中，11例（25%）发生了导致永久性残疾或死亡的迟发性缺血性功能障碍，26例（25%）发生了导致永久性残疾或死亡的迟发性缺血性功能障碍。（27.7%）94例患者在SAH后48小时内闭塞动脉瘤并清除邻近血栓，101例患者中有11例（10.9%）在SAH后48小时内进行了动脉瘤闭塞和广泛和积极清除沿着动脉（通过计算机断层扫描确定）的厚蛛网膜下腔凝块。因此，只有在SAH后48小时内沿着动脉广泛、积极地清除蛛网膜下腔血凝块，早期手术才是减少严重迟发性缺血性功能障碍发生的有效和可靠方法。
The effect of removal of subarachnoid blood clots on the prevention of delayed ischemic deficit was evaluated in 239 consecutive patients with ruptured supratentorial non-giant aneurysms. All patients were hospitalized within 24 hours after subarachnoid hemorrhage (SAH) and were classified in Grades 1 to 4 according to the system of Hunt and Hess; classification was made immediately preoperatively in patients operated on within 48 hours after SAH, or 48 hours after SAH in patients for whom delayed operation was planned. Delayed ischemic deficit causing permanent disability or death occurred in 11 (25%) of 44 patients in whom surgery was planned to be delayed for 10 days or more, in 26 (27.7%) of 94 patients in whom the aneurysms were obliterated and blood clots adjacent to them were removed within 48 hours of SAH, and in 11 (10.9%) of 101 patients in whom the aneurysms were obliterated and extensive and aggressive removal of thick subarachnoid clots lying along the arteries (identified on computerized tomographic scan) was performed within 48 hours of SAH. Accordingly, early operation is an effective and reliable method to reduce the occurrence of severe delayed ischemic deficit only when subarachnoid blood clots are removed extensively and aggressively along the arteries within 48 hours of SAH.