颅内动脉瘤夹闭或介入术后迟发性脑缺血分析  

Analysis of delayed cerebral ischemia after coiling and clipping of intracranial aneurysms

作　　者：刘朋然 靳张宁 蔡新旺 张振[1] 高南南[1] 王者[1] 杨新宇[1] LIU Peng-ran;JIN Zhang-ning;CAI Xin-wang;ZHANG Zhen;GAO Nan-nan;WANG Zhe;YANG Xin-yu(Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China)

机构地区：[1]天津医科大学总医院神经外科,300052

出　　处：《天津医药》2017年第2期176-179,共4页Tianjin Medical Journal

基　　金：国家自然科学基金资助项目(81571144)

摘　　要：目的比较并分析颅内动脉瘤患者夹闭或介入术后迟发性脑缺血(DCI)的发生情况,探讨DCI发生的危险因素。方法收集2011年3月—2014年5月天津医科大学总医院神经外科收治的CT血管造影(CTA)或全脑血管造影(DSA)检查确诊的颅内动脉瘤性蛛网膜下腔出血(a SAH)患者236例,其中135例行开颅夹闭者为夹闭组,101例行介入栓塞者为介入组,比较组间性别、年龄、既往史、术前GCS评分、Hunt-Hess分级、Fisher分级、WFNS分级、动脉瘤位置、预后等,采用二分类Logistic回归分析探讨DCI发生的危险因素。结果夹闭组中36例发生DCI(26.7%),介入组中11例发生DCI(10.9%),夹闭组发生率高于介入组(P<0.01)。对患者进行6个月随访,夹闭组和介入组预后不良率分别为17.0%和25.7%(P>0.01),总体病死率为11.0%,前者病死率低于后者(5.9%vs.17.8%,P<0.01)。Logistic回归结果显示,Fisher分级3~4级、术后肺感染、开颅手术夹闭是DCI发生的独立危险因素(P<0.01)。结论 DCI是导致动脉瘤术后患者致残率和病死率较高的重要因素,介入手术较夹闭手术动脉瘤术后DCI发生率低,密切注意DCI发生的相关危险因素能在一定程度上改善动脉瘤术后患者的预后。Objective To compare and analyze the occurrence of delayed cerebral ischemia(DCI)after coiling andclipping of intracranial aneurysms,and explore the risk factors of DCI.Methods A total of236patients with aneurysmsdiagnosed by CT angiography(CTA)or digital subtraction angiography(DSA)in Department of Neurosurgery,TianjinMedical University General Hospital were enrolled in this study from March2011to May2014.Patients were divided intoclipping group(n=135)and coiling group(n=101).The clinical characteristics were compared between two groups,includinggender,age,medical history,GCS score,Hunt-Hess grade,Fisher grade,WFNS grade,aneurysm location,prognosis andincidence of DCI.Risk factors for DCI were investigated by Logistic regression analysis.Results DCI was occurred in36patients(26.7%)underwent clipping operation while in11patients(10.9%)underwent coiling operation.The incidence wassignificantly higher in clipping group compared with that of coiling group(P<0.01).The patients were followed up for6months.The poor prognosis rates were17.0%and25.7%in clipping group and coiling group,respectively(P>0.01).Theoverall mortality was11.0%,the former had a lower mortality rate(5.9%vs.17.8%,P<0.01).According to Logisticregression analysis,Fisher Grade3-4,postoperative pulmonary infection and surgical procedure were independent riskfactors for DCI(P<0.01).Conclusion DCI is one of the most significant factors for high fatality and morbidity ofpostoperative aneurysm patients.There is a low occurrence of DCI after coiling compared with that of clipping.If we pay moreattention to risk factors associated with the DCI,it will improve the prognosis of postoperative aneurysm patients greatly.

关 键 词：颅内动脉瘤 脑缺血 危险因素 预后 夹闭 介入 迟发型脑缺血 

分 类 号：R651.122[医药卫生—外科学]