手术夹闭颅内动脉瘤术后发生慢性硬膜下血肿的风险评估  

Risk assessment of chronic subdural hematoma after surgical clipping of intracranial aneurysms

作　　者：张超[1] 刘小印 王传宝 

机构地区：[1]汉中市中心医院神经外科,陕西省723000

出　　处：《中国脑血管病杂志》2018年第2期63-67,共5页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的比较手术夹闭颅内未破裂动脉瘤(UIA)与颅内破裂动脉瘤(RIA)后慢性硬膜下血肿(CSDH)的发生率及其危险因素。方法回顾性连续纳入2006年1月至2015年12月在汉中市中心医院神经外科行动脉瘤夹闭术的410例UIA患者和464例RIA患者,根据术后有无CSDH(经头部CT平扫评估硬膜下积液及其程度)的发生,比较UIA与RIA患者动脉瘤夹闭术后CSDH发生率的差异,并通过Logistic回归分析评价术后CSDH发生的危险因素。结果 (1)UIA动脉瘤夹闭术后CSDH的发生率高于RIA[11.0%(45/410)比3.0%(14/464)],差异有统计学意义(P<0.01)。UIA患者CSDH因神经系统损伤症状而需手术治疗率也高于RIA患者[35.6%(16/45)比28.6%(4/14),P<0.05]。(2)多因素Logistic回归分析显示,动脉瘤未发生破裂(OR=2.59,95%CI:2.19~3.06,P<0.01)、硬膜下积液≥5 mm(OR=1.98,95%CI:1.94~2.03,P<0.01)和CT值≥40 HU(OR=2.87,95%CI:2.65~3.01,P<0.01)是颅内动脉瘤患者术后发生CSDH的独立危险因素。结论 UIA夹闭术后CSDH的发生率明显高于RIA,颅内动脉瘤未破裂、硬膜下积液≥5 mm和CT值≥40 HU是颅内动脉瘤CSDH发生的独立危险因素。Objective To compare the incidence of chronic subdural hematoma（CSDH） and its risk factors after surgical clipping unruptured intracranial aneurysms（UIA） and ruptured intracranial aneurysms（RIA）. Methods From January 2006 to December 2015,410 consecutive patients with UIA and 464 patients with RIA treated with aneurysm clipping at the Department of Neurosurgery,Hanzhong Central Hospital were enrolled retrospectively. According to whether having postoperative CSDH or not（evaluating subdural effusion and its degree with head CT scan）,the difference of the incidence of CSDH after aneurysm clipping in patients with UIA and RIA were compared,and logistic regression analysis was used to evaluate the risk factors for the occurrence of postoperative CSDH. Results（1） The incidence of CSDH after UIA clipping was higher than that of RIA（11. 0% [45/410]vs. 3. 0% [14/464]）. There was significant difference（P〈0. 01）. The rate of surgical treatment for CSDH because of the symptoms of nervous system injury in patients with UIA was higher than that in patients with RIA（35. 6% [16/45]vs. 28. 6% [4/14],P〈0. 05）.（2） Multivariate logistic regression analysis showed that unruptured aneurysms（OR,2. 59,95% CI 2. 19-3. 06,P〈0. 01）,subdural effusion ≥5 mm（OR,1. 98,95% CI 1. 94-2. 03,P〈0. 01）,and CT value ≥40 HU（OR,2. 87,95 % CI 2. 65-3. 01,P〈0. 01） were the independent risk factors for postoperative CSDH in patients with intracranial aneurysm. Conclusions The incidence of CSDH was significantly higher than that of RIA after UIA clipping. UIA,subdural effusion ≥5 mm,and CT value ≥40 HU were the independent risk factors for CSDH of intracranial aneurysms.

关 键 词：颅内未破裂动脉瘤 颅内破裂动脉瘤 慢性硬膜下血肿 硬膜下积液 危险因素 

分 类 号：R651.12[医药卫生—外科学]