目的:比较血管内栓塞术与显微开颅夹闭术对颅内前循环动脉瘤患者血流动力学及生活质量的影响。方法:以2014年1月至2018年12月临汾市中心医院收治的颅内前循环动脉瘤患者63例为研究对象，根据患者手术不同，分为A组(显微开颅夹闭术)30例和B组(血管内栓塞术)33例。比较两组患者术前(T0)、术中(T1)、术毕(T2)及术后24 h(T3)心率、收缩压、舒张压、心输出量、每搏心输出量和心脏排血指数的变化情况，出院时采用MOS健康状况调查问卷(SF-36)评价患者生活质量，通过格拉斯哥预后评分(GOS)量表评估两组患者术后3个月预后状况，分别采用日常生活活动能力和改良Barthel指数量表评估患者术后2年生活质量和并发症的发生情况。结果:相比A组，B组T1时心脏排血指数[(2.86±0.63)L·minn -1·(mn 2)n -1比(3.39±0.83)L·minn -1·(mn 2)n -1]明显升高，心率[(90±15)次/min比(79±9)次/min]、收缩压[(132±18)mmHg比(123±9)mmHg]、舒张压[(96±13)mmHg比(89±12)mmHg]和每博心输出量[(88.64±18.53)mL比(78.54±13.35)mL]均明显下降(n t＝2.50、3.61、2.89、2.63、3.02，均n P<0.05)；相比A组，B组T2时心率[(86±12)次/min比(75±11)次/min]、收缩压[(134±20)mmHg比(122±11)mmHg]和舒张压[(93±11)mmHg比(77±14)mmHg]均明显下降，T3时收缩压[(128±13)mmHg比(113±14)mmHg]和舒张压[(85±9)mmHg比(78±13)mmHg]均明显下降(n t＝2.68、3.14、3.95、4.15、3.05，均n P<0.05)。B组出院时SF-36量表中的精力[(55.07±8.76)分]、生理职能[(53.65±8.62)分]、生理功能[(62.25±9.53)分]、精神健康[(72.26±13.95)分]、情感职能[(61.89±12.25)分]和总体健康[(47.63±8.61)分]评分均明显高于A组[(45.86±7.62)分、(49.21±9.76)分、(43.58±8.75)分、(50.14±10.33)分、(44.76±9.42)分、(35.86±7.60)分](n t＝4.43、2.35、8.07、7.09、6.18、5.73，均n P0.05)。随访2年，B组日常生活活动能力[(86.89±4.54)分]和改良Barthel指数量表[(1.34±0.42)分]评分均明显低于A组[(92.48±6.09)分、(2.79±0.61)分](n t＝4.15、11.07，均n P0.05)。n 结论:对颅内前循环动脉瘤患者而言，显微开颅夹闭术与血管内栓塞术的治疗效果相当，后者术中血流动力学状态较稳定，且出院时短期预后效果较好，但远期预后可能差于显微开颅夹闭术。“,”Objective:To compare the effects of two different surgical methods (endovascular embolization and microsurgical craniotomy) on hemodynamics and quality of life in patients with anterior circulation aneurysms.Methods:From January 2014 to December 2018, 63 patients with anterior circulation aneurysms in Linfen Central Hospital were divided into group A (micro craniotomy) 30 cases and group B (intravascular embolization) 33 cases according to the different operation method.The changes of heart rate, systolic blood pressure, diastolic blood pressure, cardiac output, cardiac output per stroke and cardiac output index were compared between the two groups before operation (T0), during operation (T1), after operation (T2) and 24 hours after operation (T3). The quality of life of the patients was evaluated by the MOS 36-item short-form health status survey (SF-36) at the time of discharge from hospital, and the prognosis of the patients at three months after operation was evaluated by Glasgow outcome score (GOS). The quality of life and complications were evaluated by the ability of daily living and the modified Barthel index.Results:Compared with group A, group B showed a significant increase in cardiac output index[(2.86±0.63)L·minn -1·(mn 2)n -1 vs.(3.39±0.83)L·minn -1·(mn 2)n -1], a significant decrease in heart rate[(90±15)times/min vs.(79±9)times/min], systolic blood pressure[(132±18)mmHg vs.(123±9)mmHg], diastolic blood pressure[(96±13)mmHg vs.(89±12)mmHg] and cardiac output per stroke[(88.64±18.53)mL vs.(78.54±13.35)mL] at T1 (n t=2.50, 3.61, 2.89, 2.63, 3.02, all n P< 0.05). Compared with group A, group B showed a significant decrease in heart rate[(86±12)times/min vs.(75±11)times/min], systolic blood pressure[(134±20)mmHg vs.(122±11)mmHg] and diastolic blood pressure[(93±11)mmHg vs.(77±14)mmHg] at T2, and a significant decrease in systolic blood pressure[(128±13)mmHg vs.(113±14)mmHg] and diastolic blood pressure[(85±9)mmHg vs.(78±13)mmHg] at T3 (n t=2.68, 3.14, 3.95, 4.15, 3.05, all n P<0.05). The scores of energy[(55.07±8.76)points], physiological function[(53.65±8.62)points], physiological function[(62.25±9.53)points], mental health[(72.26±13.95)points], emotional function[(61.89±12.25)points] and overall health[(47.63±8.61)points] in SF-36 scale in group B were significantly higher than those in group A[(45.86±7.62)points, (49.21±9.76)points, (43.58±8.75)points, (50.14±10.33)points, (44.76±9.42)points, (35.86±7.60)points](n t=4.43, 2.35, 8.07, 7.09, 6.18, 5.73, all n P0.05). After 2 years of follow-up, the scores of activities of daily living[(86.89±4.54)points] and modified Barthel index[(1.34±0.42)points] in group B were significantly lower than those in group A[(92.48±6.09)points, (2.79±0.61)points](n t=4.15, 11.07, all n P0.05).n Conclusion:For the patients with anterior circulation aneurysms, the therapeutic effect of microsurgical craniotomy and endovascular embolization is the same, but the latter can stabilize the hemodynamic state of the patients during the operation, and the short-term prognosis is better at discharge, but the long-term prognosis may be worse than that of microsurgical craniotomy.