临床神经外科杂志2025，Vol.22Issue(3)：278-283,290,7.DOI:10.3969/j.issn.1672-7770.2025.03.007
不同治疗方式对高分级动脉瘤性蛛网膜下腔出血患者生存时间的影响
Impact of different treatments on the survival time of patients with poor-grade aneurysmal subarachnoid hemorrhage
摘要
Abstract
Objective To investigate the impact of treatment methods on the survival status of patients with poor-grade aneurysmal subarachnoid hemorrhage.Methods The clinical data of 376 patients with Hunt Hess grade Ⅳ-Ⅴ cerebral aneurysmal subarachnoid hemorrhage in the Department of Neurosurgery,Northern Jiangsu People's Hospital from October 2014 to December 2021 were analyzed retrospectively.The Kaplan Meier method was used to describe the distribution of survival time and the Log-rank test was used to analyze the influence of different treatment methods on survival time.One year after onset,the prognosis of patients was evaluated with the modified Rankin scale(mRS).Results Among the 376 patients,154 patients were treated conservatively and 222 patients were surgically treated.The median survival time of patients with conservative treatment was 4 days.The three-day,one-week,two-week,three-week,one-year and long-term survival rates were 66.2％,26.0％,12.3％,5.8％,1.9％and 1.3％,correspondingly.Among 222 surgically treated patients,145 patients received micro-clipping surgery,whose median survival time was 1 296 days.The three-day,one-week,two-week,three-week,one-year and long-term survival rates were 89.0％,69.0％,62.1％,57.2％and 47.6％,correspondingly.Seventy-seven patients underwent interventional embolization.The three-day,one-week,two-week,three-week,one-year and long-term survival rates were 98.7％,81.8％,71.4％,70.1％and 66.2％,correspondingly.The results of the Log-rank test indicated a strong correlation between treatment methods,surgical modes,and survival rates(all P＜0.05).According to the mRS scores,there were significant differences in prognosis among patients with different treatment methods(P＜0.01),and conservative treatment showed poorer outcomes.Similarly,significant differences were observed in prognosis among patients with different surgical approaches,where interventional embolization demonstrated better outcomes(P＜0.01).Conclusions The short-term mortality of patients with poor-grade aneurysmal subarachnoid hemorrhage was high.Surgical treatment,especially interventional embolization,could significantly improve prognosis and extend the life of the patients.关键词
动脉瘤性蛛网膜下腔出血/显微手术夹闭/介入栓塞/保守治疗/生存分析Key words
aneurysmal subarachnoid hemorrhage/microsurgical clipping/interventional embolization/conservative therapy/survival analysis分类
临床医学引用本文复制引用
宋炳伟,甄勇,刘健伟,何亮,申林海..不同治疗方式对高分级动脉瘤性蛛网膜下腔出血患者生存时间的影响[J].临床神经外科杂志,2025,22(3):278-283,290,7.基金项目
中西医协同慢病管理研究项目(CXZH2024040-35) （CXZH2024040-35）
