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目的探讨显微外科手术联合自体骨髓干细胞动员及辛伐他汀治疗动脉瘤性蛛网膜下腔出血的临床疗效及安全性。方法选取术前Hunt-Hess分级Ⅱ-Ⅳ级动脉瘤性蛛网膜下腔出血患者69例,经显微外科动脉瘤夹闭术后随机分为2组:对照组34例,显微外科手术后常规治疗;联合治疗组35例,显微外科手术后常规治疗联合自体骨髓干细胞动员及辛伐他汀治疗。按美国国立卫生研究院制定的卒中量表(NIHSS)和巴塞尔(Bar-thel)指数评分,测定2组外周血CDl33+CD34+细胞数。结果 69例动脉瘤性蛛网膜下腔出血患者均完全夹闭动脉瘤,术后3天对照组与联合治疗组患者NIHSS评分及Barthel指数比较无显著性差异(P>0.05),术后1,3,6个月对照组与联合治疗组患者NIHSS评分及Barthel指数比较有显著性差异(P<0.05),且2组患者NIHSS评分均依次降低,Barthel指数均依次升高;术后3周对照组与联合治疗组患者外周血CDl33+CD34+细胞数均高于治疗前,且联合治疗组外周血CDl33+CD34+细胞数显著高于对照组(P<0.05)。全过程所有患者均未出现明显不良反应。结论显微外科手术联合自体骨髓干细胞动员及辛伐他汀治疗动脉瘤性蛛网膜下腔出血不仅夹闭动脉瘤祛除蛛网膜下腔出血的病因,而且通过动员自体干细胞参与受损脑组织的功能修复,是治疗动脉瘤性蛛网膜下腔出血的安全有效方法,值得临床推广。
Objective To investigate the clinical efficacy and safety of microsurgery combined with mobilization of autologous bone marrow stem cells and simvastatin in the treatment of aneurysmal subarachnoid hemorrhage. Methods Sixty-nine patients with grade-Ⅰ-Ⅳ aortic aneurysm subarachnoid hemorrhage undergoing Hunt-Hess grading were selected and randomly divided into two groups: control group (34 cases) and microsurgical aneurysm Routine treatment; combined treatment group of 35 patients, microsurgery after conventional therapy combined with autologous bone marrow stem cell mobilization and simvastatin treatment. According to the National Institutes of Health Stroke Scale (NIHSS) and Basel (Bar-thel) index score, two groups of peripheral blood CDl33 + CD34 + cells. Results All 69 patients with aneurysm subarachnoid hemorrhage were completely aneurysm closed. There was no significant difference in the NIHSS score and Barthel index between the control group and the combination group on the 3 days after operation (P> 0.05) NIHSS score and Barthel index were significantly different between the control group and the combination therapy group (P <0.05) at 3 and 6 months. NIHSS scores of both groups were successively decreased and Barthel index increased in turn. After 3 weeks of operation, The number of CD133 + CD34 + cells in peripheral blood of patients in combination group and combination group were higher than those before treatment, and the number of CD133 + CD34 + cells in combination group was significantly higher than that in control group (P <0.05). The whole process of all patients showed no significant adverse reactions. Conclusion Microsurgery combined with autologous bone marrow stem cell mobilization and simvastatin in the treatment of aneurysmal subarachnoid hemorrhage not only obviate the cause of subarachnoid hemorrhage by clipping the aneurysm but also involve in the repair of impaired brain tissue by mobilizing autologous stem cells , Is a safe and effective method of treatment of aneurysmal subarachnoid hemorrhage, worthy of clinical promotion.