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目的 对比分析不同时期住院治疗的颅内动脉瘤患者的临床资料,探讨入院后动脉瘤再破裂率下降的可能原因.方法 回顾性纳入2005年1月至2008年12月(2005～2008年组,458例)和2013年1月至2014年12月(2013～2014年组,1 446例)四川大学华西医院神经外科收治的颅内动脉瘤性蛛网膜下腔出血(aSAH)患者.比较2组患者入院后动脉瘤的再破裂率,分析年龄、性别、Hunt-Hess分级、入院的收缩压、是否使用抗纤溶药物、动脉瘤部位、院前等待时间、术前等待时间及总体住院时间等指标对动脉瘤再破裂的影响.结果 2005～2008年组入院后动脉瘤的再破裂率为13.8％ (63/458),2013 ～ 2014年组为2.8％ (40/1 446),差异有统计学意义(P＜0.01).2005～2008年组与2013～2014年组院前等待时间中位数(四分位数间距)分别为4(9)、1(4)d;术前等待时间分别为5(4)、3(2)d;整体住院时间分别为14(9)、11(7)d,差异均有统计学意义(均P＜0.01).其余指标比较差异均无统计学意义(均P ＞0.05).结论 提高动脉瘤处理效率是减少入院后再破裂风险及提高患者预后的重要手段.

Objective To study the possible reasons for dramatic decrease of in-hospital re-bleeding of intracranial aneurysms by comparison between different time periods.Methods The data of patients with aneurysmal subarachnoid hemorrhage were analyzed retrospectively in this study who underwent treatment at Neurosurgery Department of West China Hospital in two periods,including January 2005-December 2008 (458 cases) and January 2013-December 2014 (1 446 cases).The patient's age,gender,Hunt-Hess grade,systolic blood pressure,history of anti-fibrinolytic medication,aneurysm location,admission waiting days,surgery waiting days and total hospital stay were compared between the two groups.Their relations to re-bleeding rate were analyzed.Results In the 2005-2008 group,the re-bleeding rate was 13.8％ (63/458),and it was 2.8％ (40/1 446) in the 2013-2014 group.The difference was statistically significant (P ＜0.01).In the 2005-2008 group and 2013-2014 group,admission waiting days [M(Q)] were 4 (9) days and 1 (4) days,respectively;surgery waiting days were 5 (4) days and 3(2) days,respectively;and total hospital stay were 14(9) days and 11(7) days,respectively.All the differences above were statistically significant (P ＜ 0.01).The difference in other factors were not statistically significant(all P ＞ 0.05).Conclusion Efficient management of aneurysms might greatly decrease the rate of in-hospital re-bleeding and lead to better outcomes.