支架辅助栓塞急性期颅内宽颈破裂动脉瘤的并发症危险因素分析  

Analysis of risk factors for the complications of stent-assisted embolization of acutely ruptured wide- necked intracranial aneurysms

作　　者：黄志伟[1] 李学东[1] 覃军[1] 陆建吾[1] 黄河清[1] 

机构地区：[1]广西医科大学第四附属医院神经外科,广西柳州545005

出　　处：《中华神经外科杂志》2016年第4期380-384,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨使用支架辅助栓塞急性期颅内宽颈破裂动脉瘤的手术相关并发症的危险因素。方法回顾性分析2008年5月至2014年4月广西医科大学第四附属医院神经外科使用支架辅助栓塞治疗的56例急性期宽颈破裂动脉瘤患者，共58个动脉瘤。针对年龄、性别、动脉瘤特征、Hunt．Hess分级、支架类型、支架置入方式、是否行侧脑室外引流进行单因素分析及多元Logjstic回归分析，找寻手术相关并发症的影响因素。结果与手术相关的并发症共9例（16％），其中血栓形成6例（11％），出血3例（5％）。单因素分析结果显示，术前Hunt—Hess分级（P=0．001）、动脉瘤部位（P=0．001）、支架类型（P=0．012）、支架技术（P=0．009）可能是影响术后并发症的因素。Logistic回归分析提示大脑中动脉动脉瘤（OR值：20．103，95％CI：3．182—54．365，P：0．012）、术前Hunt—Hess分级Ⅳ一V级（OR值：7．230，95％CI：1．953～22．152，P=0．022）与支架补救途径技术（OR值：1．819，95％C1：1．164—2．065，P=0．048）为支架辅助栓塞急性期颅内宽颈动脉瘤患者发生并发症的独立危险因素。结论颅内动脉瘤发生于大脑中动脉、术前Hunt—Hess分级Ⅳ一V级以及采用支架补救途径技术的急性期颅内宽颈动脉瘤破裂出血的患者更易出现并发症。Objective To analyze the risk factors for the complications of stent-assisted embolization of acutely ruptured wide-necked intracranial aneurysms. Methods A total of 56 patients with acutely ruptured aneurysm （58 aneurysms） treated with the stent-assisted embolization at the Department of Neurosurgery, the Fourth Affiliated Hospital of Guangxi Medical University from May 2008 to April 2014 were analyzed retrospectively. Univariate factor analysis and multiple logistic regression analysis were conducted aiming at age, sex, aneurysm characteristics, Hunt-Hess grade, stent type, stent implantation mode, and whether performing lateral ventricular external drainage or not. The influencing factors of procedure-related complications were found. Results Nine patients had perioperative complication （16%）, including thrombosis in 6 cases （ 11% ） and hemorrhage in 3 cases （5%）. The preoperative Hunt-Hess grade （ P = 0. 001 ）, location of aneurysms （ P = 0. 001 ）, type of stent （ P = 0. 012 ） , and stent technology （P = 0. 009） might be the influencing factors of postoperative complications. Logistic regression analysis indicated that the middle cerebral artery aneurysms （ OR, 20. 103, 95% CI 3. 182 - 54. 365, P = 0.012）, preoperative Hunt-Hess grade 1V-V （OR, 7.230, 95% CI 1.953 -22. 152, P =0.022）, and bailout stent placement （ OR, 1. 819, 95% CI 1. 164 - 2. 065, P = 0. 048） were the independent risk factors for the complications of stent-assisted embolization in patients with acute intracranial wide-neck aneurysms. Conclusion Intracranial aneurysm occurs in the middle cerebral artery, preoperative Hunt- Hess grade IV - V, and patients with acute intracranial wide-neck aneurysm rupture using bailout stent placemen are more prone to complications.

关 键 词：颅内动脉瘤 动脉瘤 破裂 血管内操作 并发症 危险因素 

分 类 号：R743[医药卫生—神经病学与精神病学]