形态学和血流动力学参数对夹闭术中颅内动脉瘤破裂的预测价值  

Predictive value of intracranial aneurysm morphology and hemodynamic parameters for aneurysm rupture during clipping

作　　者：连烨[1] 金晓[1] 张秀卿[1] LIAN Ye;JIN Xiao;ZHANG Xiuqing(The First People's Hospital of Nanyang,Nanyang 473000,China)

机构地区：[1]南阳市第一人民医院,河南南阳473000

出　　处：《中国实用神经疾病杂志》2020年第19期1691-1696,共6页Chinese Journal of Practical Nervous Diseases

基　　金：南阳市医学科技发展计划项目(编号:KJGG2018082)。

摘　　要：目的通过检测动脉瘤的形态学参数和血流动力学参数,分析影响夹闭术中颅内动脉瘤破裂的危险因素及对动脉瘤破裂的预测价值。方法纳入201610—202002在南阳市第一人民医院接受手术夹闭治疗的动脉瘤患者177例,术中动脉瘤破裂者32例,未破裂者145例;记录患者治疗前的一般临床指标:性别、年龄、伴随的基础疾病和动脉瘤的位置;应用CT血管成像模型和计算流体学方法获取动脉瘤的形态学参数和血流动力学参数;采用多因素Logistic回归分析影响动脉瘤破裂的危险因素,ROC曲线分析危险因素对预测动脉瘤破裂的临床价值。结果动脉瘤破裂组患者的动脉瘤最长径(14.7±5.2)mm和AR(1.6±0.7)均显著高于动脉瘤未破裂组[(12.5±4.7)mm、(1.3±0.5),P<0.05];动脉瘤破裂组NWSSM值(0.57±0.10)显著低于动脉瘤未破裂组(0.89±0.13)(P<0.05),动脉瘤WSSGA(12.14±4.13)Pa/m和LSQR 0.35(0.15~0.86)显著高于动脉瘤未破裂组(P<0.05)。动脉瘤最长径、AR和NWSSM为影响动脉瘤破裂的独立危险因素,术前对动脉瘤破裂均具有一定的预测价值。结论动脉瘤最长径、AR和NWSSM为夹闭术中动脉瘤破裂的独立危险因素,对动脉瘤破裂具有一定的预测价值。Objective To analyze the morphological parameters and blood flow parameters of aneurysm,analyze the risk factors affecting the rupture of aneurysm during clipping and its predictive value for rupture of aneurysm.Methods We enrolled 177 patients with aneurysms who underwent surgical clipping treatment in Nanyang First People's Hospital from October 2016 to February 2020,32 patients with ruptured aneurysm and 145 patients without rupture during operation.Records The general clinical indicators of the patient before treatment:gender,age,accompanying underlying disease and location of aneurysm;Apply CT angiography model and computational fluidics to obtain aneurysm morphological parameters and hemodynamic parameters;Multi factor Logistic regression analysis was used to analyze the risk factors affecting aneurysm rupture.ROC curve analysis was used to analyze the predictive value of risk factors for aneurysm rupture.Results The longest diameter of the aneurysm(14.7±5.2)mm and AR(1.6±0.7)in the ruptured aneurysm group were significantly higher than the longest diameter(12.5±4.7)mm and AR(1.3±0.5)(P<0.05).The NWSSM value(0.57±0.10)of patients with ruptured aneurysm group was significantly lower than that of unruptured aneurysm group(0.89±0.13)(P<0.05),WSSGA(12.14±4.13)Pa/m and LSQR 0.35(0.150.86)significantly higher than the unruptured aneurysm group(P<0.05).The longest diameter of aneurysm,AR and NWSSM are independent risk factors that affect the rupture of aneurysm,and they have certain predictive value for rupture of aneurysm before surgery.Conclusion The longest diameter of aneurysm,AR and NWSSM are independent risk factors for aneurysm rupture during clipping operation,and have certain predictive value for aneurysm rupture.

关 键 词：动脉瘤 手术夹闭 形态学参数 血流动力学参数 预测价值 危险因素 

分 类 号：R739.41[医药卫生—肿瘤]