已破裂前循环动脉瘤外科手术夹闭治疗预后的相关因素分析  

Analysis on prognostic related factors of aneurysm clipping of ruptured anterior circulation aneurysms

作　　者：徐兴国[1] 陈一笑 曹轲[1] 王林林[1] 李东蛟 兰朋朋 杨振兴[2] 冯进[2] 万定[2] 黄德俊[2] 李宗正[2] 

机构地区：[1]宁夏医科大学临床医学院,银川750004 [2]宁夏医科大学总医院神经外科

出　　处：《临床神经外科杂志》2016年第3期204-208,共5页Journal of Clinical Neurosurgery

摘　　要：目的探讨已破裂前循环动脉瘤外科手术夹闭治疗预后的相关因素。方法回顾性分析61例经外科手术夹闭治疗的已破裂前循环动脉瘤患者的临床资料,包括患者年龄、出血次数、Hunt-Hess评分、Fisher评分等。患者出院后6个月的预后情况采用改良的Rankin量表评分(mRS)作为评分标准。先对可能影响预后的因素进行单因素分析,再将单因素分析有统计学意义的因素纳入多因素Logistic回归进行分析。结果单因素分析提示出血次数、Hunt-Hess评分、GCS评分、Fisher评分、术后有无脑血管并发症、术后有无颅内感染与预后相关(均P<0.05),多因素分析提示Hunt-Hess评分(OR=40.243)、Fisher评分(OR=12.820)、术后脑血管并发症(OR=39.469)是影响已破裂前循环动脉瘤预后的独立危险因素(均P<0.05)。结论 Hunt-Hess评分、Fisher评分、术后有无脑血管并发症是显著影响已破裂前循环动脉瘤外科手术夹闭治疗患者预后的因素,重视这些因素的预测价值对降低已破裂前循环动脉瘤术后的病死率和致残率有重要临床意义。Objective To investigate the prognostic related factors of ruptured anterior circulation aneurysms underwent surgical aneurysm clipping. Methods The medical data in 61 cases of ruptured aneurysm treated by clipping were analyzed retrospectively,including general data, Hunt-Hess grade on admission, bleeding times, Fisher grade on admission, etc. The patient ＂s prognosis situation adopted the modified Rankin scale Score（mRS） as the evaluation standard when discharge from hospital 6 months. Firstly the possible factors were performed the single factor analysis, then the factors with statistic significance in the single factor analysis were performed the multiple factors logistic regression analysis. Results The single factor analysis indicated that the bleeding times, Hunt-Hess grade on admission, Glasgow coma scale（GCS） grade, CT Fisher grading, Postoperative cerebrovascular complications and intracranial infection were significantly correlated with the prognosis （P 〈 0.05）. The muhiple factors analysis indicated that HuntzHess grade on admission, CT Fisher grading, Postoperative cerebrovascular complications were the independent risk factors affecting the prognosis of patients（P 〈 0.05 ）. Conclusion Hunt-Hess grade on admission, CT Fisher grading, Postoperative cerebrovascular complications can Significantly affect the prognosis of the patients with ruptured anterior circulation aneurysms after clipping. Paying attention to the predictive value of these predictors has important clinical significance to reduce the postoperative mortality rate and disability rate in the patients with ruptured anterior circulation aneurysms.

关 键 词：前循环动脉瘤 动脉瘤夹闭术 预后 

分 类 号：R651.1[医药卫生—外科学]