[Causes of poor results of early surgery in ruptured intracranial aneurysms in elderly patients].
[Causes of poor results of early surgery in ruptured intracranial aneurysms in elderly patients].
复制标题
老年颅内动脉瘤破裂早期手术效果不佳的原因分析
DOI：
10.2176/nmc.28.1157
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发表时间：
1988
影响因子：
1.9
通讯作者：
M. Nagashima
中科院分区：
文献类型：
--
作者：
A. Suzuki;N. Yasui;H. Hadeishi;I. Sayama;K. Asakura;M. Nagashima
比较老年和年轻人群中影响颅内动脉瘤破裂早期手术（72小时内）疗效的因素，并分析老年患者疗效相对较差的原因。在本研究中，“老年人”定义为65岁或以上，因为这些患者的结局明显较差。老年患者41例（男13例，女28例; 68 3岁），年轻患者179例（男97例，女82例; 52 8岁）。在发病后3个月评估术后结局，根据进行日常活动的能力进行评分。依赖和死亡的患者被分级为预后不良。术前神经功能状态按Hunt和Kosnik分级法进行分级，排除严重系统性疾病因素。3-5级的老年患者比例明显高于年轻患者（P<0.05）。无论年龄大小，2级患者的结局无显著差异。然而，在3-5级患者中，老年组的结局明显较差（p <0.05）。因此，对3-5级老年患者预后不良的可能原因进行了分析。特别研究了病史、动脉瘤再破裂、术前计算机断层扫描结果、手术并发症、血管痉挛以及全身和神经系统术后并发症。血管痉挛和一般术后并发症被确定为老年人预后不良的重要原因。此外，老年组中严重血管痉挛的发生率显著较高（p<0.025）。术后并发症中，老年患者心力衰竭发生率明显高于老年患者（P<0.005）。所有发生一般并发症的患者也有血管痉挛，7例心力衰竭老年患者中有5例发生严重血管痉挛。这些结果表明，在老年患者中，早期手术治疗颅内动脉瘤破裂后的不良结局可归因于术前神经系统状态不良、血管痉挛和一般术后并发症的高发生率。
Factors affecting the outcome of early surgery (within 72 hours) for ruptured intracranial aneu rysms were compared in an elderly and a younger population, and the causes of the relatively poor results among the elderly patients were analyzed. In this study, "elderly" was defined as 65 years of age or older, since the outcome was significantly poorer in these patients. There were 41 elderly patients (13 males and 28 females; 68±3 years old) and 179 younger patients (97 males and 82 females; 52±8 years old). The postoperative outcome, evaluated 3 months after onset, was rated in terms of the ability to carry out daily activities. Dependent and deceased patients were graded as having a poor outcome. The preoperative neurological status was graded according to the classifica tion of Hunt and Kosnik, excluding the factor of serious ystemic diseases. The proportion of elderly patients of grades 3-5 was significantly higher than that of younger patients (P<0.05). There was no significant difference in outcome among patients of grade 2, regardless of age. However, among patients of grades 3-5, the outcome was significantly poorer in the elderly group (p <0.05) . Therefore, the possible causes of the poor outcome among elderly patients of grades 3-5 were ex amined. Medical history, aneurysm rerupture, preoperative computed tomographic findings, sur gical complications, vasospasm, and general and neurological postoperative complications were studied in particular. Vasospasm and general postoperative complications were identified as signifi cant causes of poor outcome among the elderly. In addition, the incidence of severe vasospasm was significantly higher in the elderly group (p<0.025). In terms of general postoperative complica tions, the incidence of heart failure was significantly higher in the elderly patients (p<0.005). All patients who developed general complications also had vasospasm, and five of the seven elderly patients with heart failure developed severe vasospasm. These results suggest hat, among elderly patients, poor outcome following early surgery for ruptured intracranial aneurysm is attributable to high incidences of poor preoperative neurological status, vasospasm, and general postoperative complications.