颅内破裂动脉瘤介入术中再破裂的因素及防治方法  

Factors and prevention methods of re-rupture during interventional operation of intracranial ruptured aneurysm

作　　者：孙健 刘惠祥[1] 邱耀忠 李建 季东凯 SUN Jian;LIU Hui-xiang;QIU Yao-zhong(Department of Military Surgery,Zhangjiagang Hospital Affiliated to Suzhou University,Zhangjiagang Jiangsu 215600,China)

机构地区：[1]苏州大学附属张家港医院神经外科,江苏张家港215600

出　　处：《临床和实验医学杂志》2020年第17期1851-1854,共4页Journal of Clinical and Experimental Medicine

基　　金：江苏省青年医学人才基金项目(编号:QNRC2016740)。

摘　　要：目的探讨颅内破裂动脉瘤介入术中再破裂的因素及防治方法。方法回顾性选择2015年1月至2019年12月苏州大学附属张家港医院收治的颅内破裂动脉瘤患者98例。收集术中再破裂的相关危险因素,如动脉瘤大小、位置和形状,手术时机,术中载瘤动脉痉挛与否等。采用单因素和多因素logistics回归分析方法进行研究,并探讨相应的防治方法。结果血管内介入治疗过程中发生的动脉瘤再破裂共12例。单因素分析发现,高血压病史、动脉瘤直径大小、动脉瘤部位、动脉瘤形状和手术中是否有载瘤动脉痉挛是影响颅内破裂动脉瘤介入术中再破裂的因素。多因素逐步Logistic回归分析发现,动脉瘤直径(<3 mm)(OR=3.422,95%CI:1.932~5.873,P <0.001)、动脉瘤部位(位于前交通动脉的动脉瘤)(OR=3.241,95%CI:1.721~5.320,P <0.001)以及手术中是否有载瘤动脉痉挛(OR=2.093,95%CI:1.293~3.942,P=0.003)是影响颅内破裂动脉瘤介入术中再破裂的重要危险因素。结论影响颅内破裂动脉瘤介入术中再破裂的因素众多,术者应对可能引起再破裂的各种因素足够重视,提高操作水平,从而避免再破裂的发生。Objective To explore the factors and prevention methods of re-rupture during interventional procedures of intracranial ruptured aneurysms.Methods To retrospectively select 98 patients with intracranial ruptured aneurysms admitted in Zhangjiagang Hospital Affiliated to Suzhou University from January 2015 to December 2019 as the research objects.Relevant risk factors,such as aneurysm size,location and shape,timing of surgery,and whether or not aneurysm-containing arteries spasm during operation were selected.Single-factor and multi-factor logistics regression analysis methods were used for analysis,and corresponding prevention methods were discussed.Results Aneurysm in 12 cases re-ruptured during intravascular interventional therapy.Univariate analysis found that the history of hypertension,aneurysm diameter,aneurysm location,aneurysm shape,and whether aneurysm-containing arterial spasm during surgery were the factors that affected the re-rupture of intracranial ruptured aneurysm during intervention.Stepwise logistics regression found that the aneurysm diameter (<3 mm)(OR=3.422,95%CI:1.932-5.873,P<0.001),aneurysm site (aneurysm located in the anterior communicating artery)(OR=3.241,95%CI:1.721-5.320,P<0.001) and whether aneurysmal artery spasm during surgery (OR=2.093,95%CI:1.293-3.942,P=0.003) were important risk factors that affect the re-rupture of intracranial ruptured aneurysm during intervention.Conclusion There are many factors influencing the re-rupture of intracranial ruptured aneurysm.The surgeon should pay attention to various factors that may cause re-rupture,improve the operation level,and avoid the occurrence of re-rupture.

关 键 词：颅内动脉瘤 介入治疗 再破裂 

分 类 号：R743[医药卫生—神经病学与精神病学]