Meta-analysis Of The Efficacy Of Ultra-early Clipping Intracranial Ruptured Aneurysms

Objective: The timing of surgery is an important factor influencing the prognosis of patients with aneurysmal subarachnoid hemorrhage,but the choice of optimal timing is always controversial.At present,more and more neurosurgeons advocate super-early surgery,but can super-early surgery be able to Patients with intracranial ruptured aneurysms have a better prognosis,and the answer is not clear.The main purpose of our study was to systematically evaluate the prognosis and postoperative mortality of patients with ultra-early(<24h)and delayed(≥24h)micro-clamping intracranial ruptured aneurysms for clinical ascending clipping.The choice of surgical time in patients with intracranial ruptured aneurysms provides evidence-based evidence.Method:Systematic retrieval in pubmed,medline,embase,Wanfang,Zhiwang and other databases,collecting clinical literature related to ultra-early and delayed clipping of intracranial ruptured aneurysms,using Review Manager 5.3 software to achieve a good prognosis rate And systematic analysis of mortality.Result: A total of 9 articles,1680 patients met the inclusion criteria,of which 2 were prospective controlled studies and 7 were retrospective controlled studies.Of the1680 patients enrolled,602 were treated with ultra-early treatment and 1 078 patients were treated with delayed treatment.The prognosis rate of patients inthe ultra-early group(OR=1.79,95% CI: 1.41~ 2.28,P<0.0001),postoperative mortality(OR=0.61,95% CI: 0.39~0.94,P=0.03)and the delayed group In comparison,the differences were statistically significant.Subgroup analysis showed that the prognosis rate in the ultra-early group was significantly different from that in the sub-early group(24≤sub-early<72h,OR=1.95,95% CI:1.45~2.63,P<0.0001);high-grade aneurysm The pre-existing rate of the ultra-early group was significantly higher than that of the delayed group(OR=3.09,95% CI: 1.65~5.79,P=0.004)in the pre-Hunt-Hess classification or World Department of Neurosurgical classification(IV~V).The difference was statistically significant..There was no significant difference in mortality between the ultra-early group and the sub-early group(24≤sub-early<72h,OR=0.67,95% CI: 0.40~1.15,P=0.15);high-grade aneurysm(preoperative Hunt-Hess classification or The World Department of Neurosurgical grading was grade IV~V.The mortality rate of the ultra-early group was significantly higher than that of the delayed group(OR=0.35,95% CI: 0.16-0.78,P=0.01).Conclusion: According to the results of this meta-analysis,ultra-early clipping for the treatment of intracranial ruptured aneurysms has a higher prognosis and lower postoperative mortality than deferred treatment,and in high-grade intracranial ruptured aneurysms This conclusion is equally applicable during treatment,but there is no statistically significant difference in postoperative mortality between the early treatment and the early stage.