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

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【中图分类号】 R651 【文献标志码】 A 【文章编号】1672-7770（2025）03-0278-07

Abstract： ObjectiveTo investigate the impact treatment methods on the survival status patients with poor-grade aneurysmal subarachnoid hemorrhage.MethodsThe clinical data 376 patients with Hunt Hess grade IV- V cerebral aneurysmal subarachnoid hemorrhage in the Hospital from October 2O14 to December 2021 were analyzed retrospectively. The Kaplan Meier method was used to describe the distribution survival time and the Log-rank test was used to analyze the influence diferent treatment methods on survival time.One year after onset，the prognosis patients was evaluated with the modified Rankin scale（mRS）. ResultsAmong the 376 patients，154 patients were treated conservatively and 222 patients were surgically treated. The median survival time 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 longterm survival rates were 89.0% ， 69.0% ， 62.1% ， 57.2% and 47.6% ，correspondingly. Seventyseven patients underwent interventional embolization.The three-day，one-week，two-week，threeweek，one-year and long-term survival rates were 98.7% ， 81.8% ， 71.4% ， 70.1% and 66.2% ， correspondingly. The results 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 diferences were observed in prognosis among patients with different surgical approaches，where interventional embolization demonstrated better outcomes （ P<0.01 ）.ConclusionsThe short-term mortality patients with poor-grade aneurysmal subarachnoid hemorrhage was high. Surgical treatment， especially interventional embolization，could significantly improve prognosis and extend the life the patients.

Key words： aneurysmal subarachnoid hemorrhage； microsurgical clipping； interventional embolization；conservative therapy；survival analysis

动脉瘤性蛛网膜下腔出血（aneurysmalsubarachnoidhemorrhage，aSAH）是第三大常见的脑卒中形式，约有 20%～40% 为高分级 aSAH[1-3] ，其病情重，病死率高，如果不及时采取相关治疗措施，死亡率为 75%～100%[4-7] 。（剩余11883字）