颅内动脉瘤介入术后预后不良的危险因素分析  

An analysis of risk factors for poor prognosis of intracranial aneurysm after interventional surgery

作　　者：胡泽军[1] 陈贵杰 曹相军[1] 罗洪涛[1] 刘静[2] HU Ze-Jun;CHEN Gui-Jie;CAO Xiang-Jun;LUO Hong-Tao;LIU Jing(The First People's Hospital of Yibin,Yibin,Sichuan 644000;West China Hospital of Sichuan University,Chengdu,Sichuan 610041)

机构地区：[1]宜宾市第一人民医院,四川宜宾644000 [2]四川大学华西医院,四川成都610041

出　　处：《国际神经病学神经外科学杂志》2020年第3期225-229,共5页Journal of International Neurology and Neurosurgery

基　　金：四川省卫生计生委科研课题,项目编号:18PJ530。

摘　　要：目的分析颅内动脉瘤介入术后预后不良的危险因素。方法回顾性分析2017年1月—2019年1月于我院接受介入栓塞术的304例颅内动脉瘤患者临床资料,整理其性别、年龄、既往病史、动脉瘤情况(大小、形态、位置、数量)、术前Hunt-Hess分级、Fisher分级、手术时机、手术并发症等资料,随访至术后6个月,采用格拉斯哥预后量表(GOS)分为预后不良组与预后良好组,采用Logistic回归分析颅内动脉瘤介入术后预后不良的影响因素。结果术后6个月,预后良好224例(73.7%),预后不良80例(26.3%)。单因素分析显示,预后不良组在手术时机、术前Hunt-Hess分级、Fisher分级、AR值、并发症发生率方面与预后良好组差异有统计学意义(P<0.05),性别、年龄、合并高血压、糖尿病、动脉瘤数量、位置和直径方面与预后良好组差异无统计学意义(P>0.05);多因素Logistic回归分析显示,手术时机(OR=1.301)、术前Hunt-Hess分级(OR=1.328)、Fisher分级(OR=1.868)、AR值(OR=1.910)、合并并发症(OR=2.083)是介入术预后的危险因素(P<0.05)。结论手术时机、术前Hunt-Hess分级、Fisher分级、AR值、合并并发症是介入术预后的危险因素,针对有手术指征的动脉瘤患者尽早进行手术、积极防治并发症是改善预后、提高生活质量的有效措施。Objective To analyze the risk factors for poor prognosis of intracranial aneurysm after interventional surgery.Methods A retrospective analysis was performed on the clinical data of 304 patients with intracranial aneurysm who had undergone interventional embolization in our hospital from January 2017 to January 2019.The data of the patients were compiled according to patient's sex,age,past medical history,aneurysm condition(size,shape,location,and number),preoperative Hunt-Hess grade,Fisher grade,surgery timing,and surgical complications.The patients were followed up to 6 months after surgery.The patients were divided into poor prognosis group and good prognosis group using the Glasgow Outcome Scale.Univariate and multivariate logistic analyses were performed to assess the risk factors for poor prognosis of intracranial aneurysm after interventional surgery.Results Six months after surgery,224 cases(73.7%)had good prognosis and 80 cases(26.3%)had poor prognosis.The univariate analysis showed that there were significant differences between the poor prognosis group and good prognosis group in surgery timing,preoperative Hunt-Hess grade,Fisher grade,AR value,and incidence of complications(P<0.05),but there were no significant differences between the two groups in sex,age,incidence of concomitant hypertension and diabetes mellitus,and number,location,and diameter of aneurysms(P>0.05).The multivariate logistic regression analysis showed that surgery timing,preoperative Hunt-Hess grade,Fisher grade,AR value,and incidence of complications were influencing factors for the prognosis after interventional surgery(odds ratios=1.301,1.328,1.868,1.910,and 2.083,respectively,P<0.05).Conclusions Surgery timing,preoperative Hunt-Hess grade,Fisher grade,AR value,and incidence of concomitant complications are influencing factors for the prognosis of intracranial aneurysm after interventional surgery.Operation at the earliest possible time and proactive prevention and treatment of complications are effective measures to improve the

关 键 词：颅内动脉瘤 介入栓塞术 危险因素 预后 

分 类 号：R743.4[医药卫生—神经病学与精神病学]