摘要： 目的 评价不同治疗方案对颅内动脉瘤的疗效及不良后果，以为颅内动脉瘤的循证治疗制定最佳治疗方案。方法 以颅内动脉瘤、治疗、血管内栓塞治疗、手术夹闭治疗等英文词组作为检索词，分别检索MEDLINE、PubMed、Cochrane图书馆等数据库，并辅助手工检索获得临床指南、随机对照临床试验、系统评价、回顾性病例分析、临床对照试验及病例观察研究等方面的相关文献，采用Jadad 量表对文献质量进行评价。结果 经筛选共纳入与颅内动脉瘤治疗有关的临床指南4 篇、随机对照临床试验4 篇、系统评价7 篇、回顾性病例分析9 篇、临床对照试验1 篇、病例观察研究1 篇；其中20 篇被评为高质量文献（2 篇7 分、2 篇6 分、4 篇5 分、12 篇4 分），6 篇为低质量文献。经对各项临床试验治疗原则和不同治疗方法的疗效及安全性评价显示：（1）血管内栓塞和手术夹闭治疗是目前治疗颅内动脉瘤的主要外科手术方法，但哪种方法更具优势仍存在争议。（2）对于未破裂颅内动脉瘤的治疗，有症状者建议积极治疗；但对于无症状的小动脉瘤，是否需要治疗尚有争议，应根据各种影响因素如年龄、既往病史、家族史，以及动脉瘤大小、部位、形态和预期寿命等综合考虑。（3）对于已破裂的颅内动脉瘤，建议尽快施行手术治疗，除非急性期不能耐受手术者外，不宜采取延期治疗方案。手术方法的选择也应结合患者具体情况具体分析。（4）动脉瘤破裂后的药物治疗，除尼莫地平已获得大型随机对照临床试验证据外，其他药物治疗效果仍有待研究。结论 借助循证医学评价方法可为颅内动脉瘤患者的治疗提供最佳的临床证据。

关键词: 颅内动脉瘤, 栓塞, 治疗性, 脑血管重建术, 药物疗法, 循证医学

Abstract: Objective To evaluate the therapeutic efficacy and side effect of various treatment for intracranial aneurysms in order to formulate the best therapeutic regimen for the evidence-based treatment of intracranial aneurysms. Methods Intracranial aneurysms, treatment, endovascular coiling treatment or neurosurgical clipping treatment were used as retrieval words. MEDLINE, PubMed, Cochrane library were used for retrieval, and manual searching was also used. Related clinical guidelines, systematic reviews, randomised controlled clinical trials, controlled clinical trials, retrospective case analysis and case -observation studies were collected and evaluated by Jadad Scale. Results Twenty-six related articles were selected as follow: 4 clinical guidelines, 4 randomised controlled clinical trials, 7 systematic reviews, 9 retrospective case analysis, 1 controlled clinical trials, and 1 case-observation study. Among the above articles 20 were of high quality (2 articles with 7 points, 2 articles 6 points, 4 articles 5 points, 12 articles 4 points), while 6 were of low quality by score. According to therapeutic principle and the evaluation of therapeutic efficacy and side effects of various therapies, it is suggested that: 1) Endovascular coiling treatment and surgical clipping treatment are the two main methods of intracranial aneurysms, but it is still controversial which method is more advantage. 2) For unruptured intracranial aneurysms, there is still having controversy in whether they should be treated or not. Symptomatic unruptured intracranial aneurysms are suggested to be treated actively, but for asymptomatic small unruptured aneurysms, there is still having controversy, various factors should be comprehensively accounted, such as age, previous history, family history, the size of the aneurysm, location, morphology and life expectancy, etc. 3) For rupture intracranial aneurysms, it should be treated as soon as possible, only when the patients with poor condition, untolerating the surgical treatment in the acute period, treatment should be appropriately delayed. Before determining the treatment protocols, we should consider comprehensively the specific conditions of patients. 4) About the pharmacotherapy after aneurysmal subarachnoid hemorrhage, besides nimodipine is proved effectively by a large randomized controlled trial, other pharmacotherapies still remain controversial. Conclusion Evidence ? based medicine can provide the best clinical evidence on the treatment for intracranial aneurysms.

Key words: Intracranial aneurysm, Embolization, therapeutic, Cerebral revascularization, Drug therapy, Evidence-based medicine