后交通动脉瘤相关性动眼神经麻痹的预后影响因素分析  

Prognostic influencing factors of posterior communicating aneurysm associated with oculomotor nerve palsy

作　　者：郑匡[1] 钟鸣[1] 谭显西[1] 李则群[1] 熊叶[1] 严志远[1] Zheng Kuang;Zhong Ming;Tan Xianxi;Li Zequn;Xiong Ye;Yah Zhiyuan.(Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang Wenzhou 325000, Chin)

机构地区：[1]温州医科大学附属第一医院神经外科,浙江温州325000

出　　处：《中国医师进修杂志》2018年第3期193-197,共5页Chinese Journal of Postgraduates of Medicine

基　　金：浙江省温州市科技计划项目（Y20150211）

摘　　要：目的 探讨后交通动脉瘤相关性动眼神经麻痹患者动眼神经麻痹症状的12个月预后,并对可能的预后影响因素进行分析.方法 前瞻性临床研究,纳入39例后交通动脉瘤相关性动眼神经麻痹患者,均在术后12个月进行随访,评价动眼神经麻痹症状的预后情况.结果39例患者中,行开颅动脉瘤夹闭术16例,血管内动脉瘤栓塞术23例.单因素Logistic分析结果显示,年龄≤60岁患者动眼神经麻痹症状预后优于年龄〉60岁患者,手术时机≤14 d患者动眼神经麻痹症状预后优于手术时机〉14 d患者,差异有统计学意义（P〈0.05或〈0.01）;动脉瘤出血与否、动脉瘤朝向、动脉瘤大小、手术方式和术前动眼神经麻痹程度与后交通动脉瘤相关性动眼神经麻痹患者动眼神经麻痹症状预后无关（P〉0.05）.多因素Logistic分析结果显示,年龄和手术时机是影响后交通动脉瘤相关性动眼神经麻痹患者动眼神经麻痹症状预后的独立因素（OR=6.574和32.510,95% CI 1.119-38.640和2.869-368.363,P〈0.05或〈0.01）.结论 手术治疗动脉瘤可以改善后交通动脉瘤相关性动眼神经麻痹患者动眼神经麻痹症状的预后,而低龄和早期手术治疗的患者预后相对较好.Objective To investigate the prognosis of patients with posterior communicating aneurysm associated with oculomotor nerve palsy in 12 months, and analyze the possible prognostic influencing factors.Methods A prospective clinical study was conducted in 39 patients with posterior communicating aneurysm associated with oculomotor palsy.The patients were followed up for 12 months after surgery,and the prognosis of oculomotor palsy symptoms was evaluated.Results In 39 patients,16 cases were treated by craniotomy clipping, and 23 cases were treated by intravascular embolization. Univariate Logistic analysis result showed that the prognosis of oculomotor palsy symptoms in patient with age ≤ 60 years was significantly better than that in patient with age 〉60 years, the prognosis of the patients with operation timing≤14 d was significantly better than that of patients with operation timing〉14 d, and there were statistical differences （P〈0.05 or 〈0.01）; the aneurysm hemorrhage, aneurysm orientation, aneurysm size, surgical procedure and preoperative oculomotor nerve palsy degree were unrelated to the prognosis of oculomotor palsy symptoms （P〉0.05）. Multifactor Logistic analysis result showed that age and operation timing were the independent prognostic influencing factors of oculomotor palsy symptoms（OR=6.574 and 32.510,95% CI 1.119-38.640 and 2.869-368.363,P〈0.05 or〈0.01）. Conclusions Surgical treatment of aneurysms can improve the prognosis in patients with posterior communicating aneurysm associated with oculomotor nerve palsy,and the prognosis of patients with young age and early surgical treatment is relatively better.

关 键 词：动眼神经疾病 动脉瘤 预后 前瞻性研究 

分 类 号：R743[医药卫生—神经病学与精神病学]