Clinical Characteristics and Surgical Results of Aged Patients with Ruptured Intracranial Aneurysms Operated on in an Acute Stage
Clinical Characteristics and Surgical Results of Aged Patients with Ruptured Intracranial Aneurysms Operated on in an Acute Stage
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老年颅内动脉瘤破裂急性期手术患者的临床特点及手术结果
DOI：
10.2335/scs1987.24.5_365
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
K. Takakura
中科院分区：
文献类型：
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作者：
T. Tanikawa;K. Arai;H. Yonetani;T. Taira;F. Yamane;H. Iseki;Hiroyuki Satou;H. Kawamura;K. Takakura
我们分析了44例年龄在70岁或以上的颅内动脉瘤破裂患者的临床特征和手术结果，这些患者在出血后72小时内接受了手术。与年龄小于70岁的264名患者（126名男性和138名女性）的非老年组相比，老年组（6名男性和36名女性）显示出明显的女性优势。老年组动脉瘤破裂载瘤动脉以颈内动脉最多见，非老年组以大脑前动脉最多见。那里两组术前临床分级（Hunt & Kosnik分级）差异无统计学意义。老年组和非老年组迟发性缺血性神经功能缺损（DIND）的发生率分别为32%和34%，但老年组永久性DIND的发生率（50%）高于非老年组（36%）。对各临床分级手术结果的比较研究显示，老年组IV级患者的结局（92%不良结局）比非老年组（58%不良结局，p= 0.02）极差。虽然老年组中的III级患者也显示出较差的结局，但未达到统计学显著性。70-74岁患者亚组的总体结局与非老年组几乎相同。因此，当年龄低于75岁且临床分级低于G III时，老年患者的早期动脉瘤手术指征与非老年患者相同。在导致每位患者预后不良的因素中，老年组原发性脑损伤的发生率（53%）高于非老年组（43%）。这些结果表明，老年患者预后不良的主要原因是由于原发性出血或症状性血管痉挛引起的脑损伤恢复不良。
We analyzed clinical characteristics and surgical results in 44 patients aged 70 years or more with ruptured intracranial aneurysms operated on within 72 hours of hemorrhage. In comparison with a non-aged group of 264 patients aged less than 70 years (126 men and 138 women), the aged group (6 men and 36 women) showed a distinct female preponderance. The most common parent artery of ruptured aneurysm was the internal carotid artery in the aged group, while it was the anterior cerebral artery in the non-aged group. There. was no significant difference in the preoperative clinical grades (Hunt & Kosnik classification) between the two groups. Although delayed ischemic neurological deficit (DIND) appeared in both groups at almost the same frequencies, 32% and 34% for the aged and non-aged group, respectively, the incidence of permanent DIND was higher in the aged group (50%) than in the non-aged group (36%). The comparative studies on surgical results in each clinical grade revealed that outcomes of Grade IV patients were extremely poorer in the aged group (92% poor outcome) than those in the non-aged group (58% poor outcome, p= 0.02). Although Grade III patients in the aged group also showed poorer outcomes, it did not reach statistical significance. Overall outcomes in a subgroup of patients aged 70-74 were almost the same as those in the non-aged group. Thus indications for early aneurysm surgery in aged patients, when their ages are under 75 and clinical grades below G III , are determined with the same standards as in non-aged patients. Among the factors accounting for poor outcome of each patient, the incidence of primary brain damage was higher in the aged group (53%) than that in the non-aged group (43%). These results indicate that the major cause of poor outcomes of aged patients is a poor recovery from brain damage due to either primary hemorrhage or symptomatic vasospasm.