颅内动脉瘤在电解可脱式弹簧圈栓塞术中破裂危险因素分析及处理体会  

Risk factors and treatment experience of cerebral aneurysms rupture in the course of Gugliemi detachable coil embolization

作　　者：薛振生 

机构地区：[1]河北省邢台市第三医院神经外科,054000

出　　处：《中国医师进修杂志》2011年第14期29-31,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 探讨颅内动脉瘤在电解可脱式弹簧圈（GDC）栓塞术中发生破裂的危险因素及处理方法.方法 2000年8月至2010年6月,以GDC栓塞术治疗420例动脉瘤性蛛网膜下隙出血（SAH）患者,对其临床资料进行回顾性总结,统计分析颅内动脉瘤在GDC栓塞术中发生破裂的危险因素.结果 共16例术中发生动脉瘤破裂,发生率为3.8%（16/420）,术后13例致密填塞,3例部分填塞.单因素分析显示：SAH发作次数≥2次、瘤体≤4 mm、有假性动脉瘤、Hunt-Hess分级为Ⅳ～Ⅴ级、有高血压病史以及瘤颈窄是引起颅内动脉瘤GDC栓塞术中发生破裂的危险因素.多因素 Logistic回归分析显示：SAH发作次数≥2次（P=0.0424,OR=6.798）以及有假性动脉瘤（P=0.0069,OR=4.423）是引起颅内动脉瘤GDC栓塞术中发生破裂的独立危险因素.结论 颅内动脉瘤在GDC栓塞术中发生破裂主要与SAH多次发作以及存在假性动脉瘤有关,临床上对存在危险因素者应警惕发生术中破裂,一旦发生应积极给予合理的治疗,大多数患者能获得良好预后.Objective To investigate the risk factors and treatment experience of cerebral aneurysms rupture in the course of Gugliemi detachable coil （GDC） embolization. Methods From August 2000 to June 2010,420 patients with aneurysmal subarachnoid hemorrhage （SAH） received GDC embolization and their clinical data were retrospectively reviewed to analyse the risk factors of cerebral aneurysms rupture in the course of treatment. Results Sixteen patients had intraoperative aneurysm rupture, the incidence rate was 3.8%（16/420）,including 13 cases density filling,3 cases partial filling postoperative.Univariate analysis showed：SAH episodes ≥2 times,tumor size ≤4 mm,the presence of pseudoaneurysm,Hunt-Hess grade Ⅳ - Ⅴ as well as history of hypertension were the risk factors of cerebral aneurysms rupture in the course of GDC embolization. Logistic regression analysis showed：SAH episodes ≥2 times （P = 0.0424,OR =6.798）and the presence of pseudoaneurysm （P = 0.0069, OR = 4.423） were the independent risk factors of cerebral aneurysms rupture. Conclusions Rupture of intracranial aneurysm in the course of GDC embolization is mainly related to the multiple SAH and the presence of pseudoaneurysm. It should be alert to the risk factors and take active treatment as soon as the occurrence of rupture in clinic work, for this, most patients can get a good prognosis.

关 键 词：颅内动脉瘤 破裂 危险因素 电解可脱式弹簧圈 

分 类 号：R651[医药卫生—外科学]