Kev tsis sib haum xeeb txog lub sijhawm ntawm kev phais
Kev kho mob phais yog qhov tseem ceeb hauv kev tiv thaiv kev rov qab los ntawm cov kab mob aneurysms, txo cov teeb meem, thiab txo cov neeg tuag. Nws yog ib txoj hauv kev zoo rau kev kho mob ntawm SAH. Feem ntau, kev phais hauv 24 teev ntawm qhov pib ntawm SAH yog hu ua ultra-thaum ntxov phais; phais hauv 3 hnub yog hu ua kev phais ntxov; kev phais ntawm 3 mus rau 10 hnub yog txhais tias yog kev phais nruab nrab; phais tom qab 10 hnub txhais tau tias yog kev phais lig. Kev kho mob thaum ntxov tsis tuaj yeem txo qhov kev pheej hmoo ntawm rov los ntshav, tab sis kuj tshem tawm cov ntshav tsub zuj zuj hauv lub paj hlwb cistern, tsim cov xwm txheej rau kev kho mob tom ntej, thiab txo qhov tshwm sim thiab qhov hnyav ntawm CVS. Qhov kev pheej hmoo loj tshaj plaws ntawm kev ncua kev phais yog qhov muaj peev xwm rov los ntshav txhua lub sijhawm.
Lub hom phiaj tseem ceeb ntawm SAP kev kho yog txhawm rau oclude intracranial aneurysm los tiv thaiv rov los ntshav ntawm aneurysm. Muaj ob txoj hauv kev tseem ceeb: kev kho mob endovascular thiab craniotomy clipping. Txij li thaum muaj kev pheej hmoo ntawm rov los ntshav tom qab SAH yog siab heev thiab qhov kev mob tshwm sim tsis zoo heev thaum rov los ntshav, txawm tias xaiv craniotomy lossis endovascular kho, nws yuav tsum tau ua kom sai li sai tau txhawm rau txo qhov kev pheej hmoo ntawm rov los ntshav. Raws li kev kho mob microsurgical thiab endovascular kev kho mob ua ntej, kev ntsuam xyuas ntawm cov kev kho mob tsim nyog raws li tus neeg mob thiab aneurysm yam ntxwv tseem txhim kho.
LEEJ TWG cov lus qhia pom zoo tias kev phais ntxov raug pom zoo rau cov neeg mob qib I thiab II aneurysmal SAH, kev phais ntxov pom zoo rau cov neeg mob qib III uas nws tus mob zoo tuaj, kev phais lig raug pom zoo rau cov neeg mob qib III uas nws qhov mob hnyav dua, thiab kev phais tsis pom zoo rau qib IV. thiab V cov neeg mob. AHA cov lus qhia pom zoo pom zoo rau kev kho mob aneurysm clipping rau kev kho mob ntawm aneurysmal SAH kom txo tau qhov tshwm sim ntawm rebleeding tom qab SAH. Nws ntseeg tau tias tsis muaj pov thawj los qhia seb qhov kev kho mob ntawm kev phais thaum ntxov yog txawv ntawm qhov kev phais lig. Kev phais thaum ntxov yog pom zoo rau cov neeg mob uas muaj qib zoo dua.
Kev phais, phais ntxov lossis lig rau lwm tus neeg mob nyob ntawm qhov xwm txheej. Canadian cov lus qhia pom zoo rau kev phais ntxov rau cov neeg mob uas tau qhab nia zoo SAH thiab ceev faj hauv kev phais ib nrab vim tias nws yuav ua rau CVS qeeb. European cov lus qhia pom zoo: Kho aneurysms kom ntxov li sai tau kom txo tau qhov kev pheej hmoo ntawm rov los ntshav yog tias muaj kev tso cai; Yog tias ua tau, kev cuam tshuam yuav tsum tau ua tsis pub dhau 72 teev ntawm qhov pib tshwm sim.
Kev xaiv tus neeg mob rau kev kho mob
Cov lus qhia rau kev kho mob feem ntau muaj ob yam: 1. Yog hais tias tus neeg mob nyob rau hauv ib cheeb tsam txwv rau kev phais ncaj qha los yog tus mob tsis tso cai rau kev phais, ntau yam niam txiv cov hlab ntsha occlusion yog ua. Xws li cov aneurysms loj heev, suav nrog ntu ntu ntu ntu ntawm cov kab mob hauv qhov ntswg, ntu petrous, ntu basilar artery lossis vertebral hlab ntsha ntawm cov hlab ntsha sab hauv carotid; fusiform wide-caj dab los yog tsis muaj carotid aneurysms; phais clipping tsis ua hauj lwm; Cov kab mob hauv lub cev tsis tso cai lossis tus neeg mob tsis kam lees craniotomy 2. Khaws lub patency ntawm niam txiv cov hlab ntsha, zoo ib yam li saccular aneurysms uas tuaj yeem kho los ntawm craniotomy ncaj qha; siv stent-pab aneurysm embolization therapy los yog kho cov aneurysms loj los ntawm cov ntshav khiav cov khoom siv.
Piv nrog rau kev kho mob phais, kev kho mob endovascular interventional muaj cov yam ntxwv ntawm kev raug mob tsawg dua, tsis tshua muaj kev pheej hmoo, thiab kev qhia dav dav, thiab cov cuab yeej siv kho mob endovascular interventional tau dhau los ua neeg paub tab. Txawm li cas los xij, endovascular interventional therapy tseem muaj cov nram qab no contraindications: 1. mob vascular tortuosity thiab arteriosclerosis. 2. Lub aneurysm me dhau rau lub catheter nkag; qhov aneurysm nyob rau ntawm qhov kawg ntawm cov hlab ntsha thiab tsis tuaj yeem ncav cuag los ntawm cov cuab yeej microcatheter uas twb muaj lawm. 3. Loj aneurysms tsis haum rau embolization. 4. Cov neeg mob uas tsis tuaj yeem los ntshav tsis zoo lossis los ntshav.
Nyob rau hauv luv luv, kev kho mob phais thiab endovascular interventional kev kho mob txhua tus muaj lawv tus kheej zoo thiab kev txwv, thiab ob leeg muaj irreplaceable luag hauj lwm nyob rau hauv kev kho mob ntawm aneurysms. Lub caj dab clipping raws sij hawm los yog endovascular embolization ntawm ruptured aneurysms tom qab SAH nrog rau kev kho mob tom qab tsim nyog yog qhov tseem ceeb hauv kev txo qis lawv qhov rov tshwm sim, kev tuag thiab kev tsis taus.