血管内栓塞治疗老年破裂颅内动脉瘤的预后危险因素分析  

Analysis of the associated prognostic risk factors of ruptured intracranial aneurysms in elderly patients undergoing endovascular treatment

作　　者：陈绪亮[1] 赵兵[1] 龙彦笑 石会[1] 郑匡[1] 李则群[1] 谭显西[1] 钟鸣[1] 

机构地区：[1]温州医科大学附属第一医院神经外科,325000

出　　处：《中华神经外科杂志》2015年第3期269-272,共4页Chinese Journal of Neurosurgery

摘　　要：目的 探讨血管内栓塞治疗老年破裂颅内动脉瘤的预后危险因素.方法 对2012年1月至2013年11月温州医科大学附属第一医院神经外科经血管内栓塞治疗的90例老年破裂颅内动脉瘤患者（年龄≥60岁）进行回顾性分析.对可能影响预后的危险因素进行单因素和多因素Logistic回归分析.采用改良Rankin评分量表（mRs）评价预后,平均随访10.6个月（1～22个月）,分为预后良好（mRs评分为0～2分）和预后不良（mRs评分为3～6分）两组.结果 90例中,77例（86％）预后良好,13例（14％）预后不良.其中,入院时世界神经外科医师联盟（WFNS）的蛛网膜下腔出血分级Ⅰ～Ⅲ级的79例患者中,72例（91％）预后良好;入院时WFNS分级Ⅳ～Ⅴ级的11例患者中,5例（45％）预后良好.入院时Fisher分级1～2级的61例患者中,2例（3％）预后不良;入院时Fisher分级3～4级的29例患者中,11例（38％）预后不良.11例分流依赖性脑积水的患者中,6例（55％）预后不良.单因素分析显示,年龄、WFNS分级Ⅳ～Ⅴ级、Fisher分级3～4级、有无分流依赖性脑积水、并发症是影响预后的危险因素（均P ＜0.05）.多因素Logistic分析提示,Fisher分级3～4级、分流依赖性脑积水是预后不良的独立危险因素（OR值分别为10.4671和19.978,均P＜0.05）.结论 Fisher分级3～4级、有无分流依赖性脑积水与血管内栓塞治疗老年破裂颅内动脉瘤患者的预后相关.Objective To identify the predictors of outcomes in elderly patients undergoing coiling of ruptured cerebral aneurysms.Methods Ninety consecutive elderly patients （≥60 years）with ruptured aneurysms underwent coiling between January 2012 and November 2013.The potential factors for unfavorable outcome were evaluated by a univariate analysis and multivariate Logistic regression analysis.The outcome was measured by the modified Rankin scale （mRs） and was dichotomized into favorable （mRs 0-2） and unfavorable （3-6）.The median follow-up was 10.6 months （range,1-22 months）.Results Among the 90 patients,77 （86%） patients had a favorable outcome.Thirteen patients （14%） had an unfavorable outcome.Seventy-two （91%） of 79 patients with World Federation of Neurosurgical Societies （WFNS） grade Ⅰ-Ⅲ had a favorable outcome.Five （45%）of 11 Patients with WFNS grade Ⅳ-Ⅴ had a favorable outcome.And 2 （3%）of 61 Patients with Fisher grade 1-2 showed the poor clinical recovery,whereas 11 （38%）of 29 Patients with Fisher grade 3-4 showed the poor clinical recovery.Six（55%）of 11 Patients with shunt-dependent hydrocephalus had unfavorable outcome.Univariate analysis revealed that age,Ⅳ-Ⅴ WFNS grade,3-4 Fisher grading,shunt-dependent hydrocephalus,in-hospital complication were potential predictors for poor outcome（mRs 3-6） （P 〈 0.05）.Multivariate Logistic regression analysis showed that 3-4 Fisher grading （OR =10.4671,P 〈0.05） and shunt-dependent hydrocephalus （OR =19.978,P 〈 0.05） were independent risk factors for for poor outcome after endovascular treatment of ruptured cerebral aneurysms.Conclusions Fisher grade 3-4,shunt-dependent hydrocephalus were independent predictors of unfavorable outcomes in elderly patients undergoing coiling of ruptured cerebral aneurysms.

关 键 词：老年人 颅内动脉瘤 蛛网膜下腔出血 栓塞 治疗性 危险因素 预后 

分 类 号：R651.1[医药卫生—外科学]