老年颅内破裂动脉瘤血管内治疗的效果及安全性  

Efficacy and safety of endovascular treatment on elder patients with ruptured intracranial aneurysms

作　　者：吕国伟 姜羽 张辉 辛孟杰 张文进 Lyu Guowei;Jiang Yu;Zhang Hui;Xin Mengjie;Zhang Wenjin(Department of Neurosurgery,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属郑州中心医院神经外科,450000

出　　处：《中国实用医刊》2020年第12期10-13,共4页Chinese Journal of Practical Medicine

基　　金：郑州市重点科技攻关项目(10PTGS473)。

摘　　要：目的:评估老年颅内破裂动脉瘤患者应用血管内治疗的疗效和安全性。方法:回顾性研究郑州大学附属郑州中心医院2015年1月至2018年12月67例应用血管内治疗的老年颅内动脉瘤破裂患者的临床资料。采用U检验、卡方(或Fisher)检验进行单因素统计学分析,并进一步行多因素回归分析相关临床预后因素。结果:32例患者单独应用弹簧圈栓塞,35例患者采用支架辅助弹簧圈栓塞。所有患者在10.5个月的中位随访时间中,9例(13.4%)出现手术相关并发症。1例在随访4个月时因血栓事件去世,其余58例动脉瘤栓塞后未复发,8例(12.1%)出现复发需进一步治疗。多因素分析结果显示动脉瘤大小、是否致密栓塞与动脉瘤复发相关。入院Hunt-Hess分级、是否致密栓塞以及栓塞后稳定性与预后密切相关。结论:老年患者应用血管内治疗破裂动脉瘤是安全且有效的治疗方案,未致密栓塞的大动脉瘤术后复发常见。入院Hunt-Hess级别高、未致密栓塞以及栓塞后复发预示较差的临床预后。Objective To assess the efficacy and safety of endovascular treatment in elderly patients with intracranial ruptured aneurysms.Methods A retrospective study of 67 elderly patients with ruptured intracranial aneurysm treated by endovascular therapy in Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2015 to December 2018 were included.Univariate statistical analysis was performed by U test,Chi-square test(or Fisher’s test),the clinical prognostic factors were further analyzed by multivariate regression analysis.Results Thirty-two patients underwent coil embolization alone,and 35 patients underwent stent-assisted coil embolization.During the median follow-up of 10.5 months,9 patients(13.4%)had surgery-related complications.One patient died of a thrombotic event at 4 months of follow-up,the remaining 58 patients had no recurrence after embolization,and 8 patients(12.1%)had recurrence requiring further treatment.Multivariate analysis showed that the aneurysm size and whether it was dense embolism were associated with recurrence of the aneurysm.The Hunt-Hess grade,whether it was dense embolization,and post-embolization stability were closely related to prognosis.Conclusions Endovascular treatment of ruptured aneurysms in elderly patients is a safe and effective treatment.Recurrence of large aneurysms without dense embolization is common.High-grade Hunt-Hess admission,uncompromised embolization,and recurrence after embolization indicate a poor clinical outcome.

关 键 词：颅内动脉瘤 血管内治疗 老年 

分 类 号：R651.12[医药卫生—外科学]