前交通动脉破裂动脉瘤的预后影响因素分析  

Prognostic factors for ruptured anterior communicating artery aneurysms

作　　者：孙阳阳 杨振兴[2] 朱辰路 黄德俊[2] 李宗正[2] Sun Yangyang;Yang Zhenxing;Zhu Chenlu;Huang Dejun;Li Zongzheng(Graduate school,Ningxia Medical University,Yinchuan 750004,China;Department of Neurosurgery,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Second Clinical Medical College,Lanzhou University,Lanzhou 730030,China)

机构地区：[1]宁夏医科大学研究生学院,银川750004 [2]宁夏医科大学总医院神经外科,银川750004 [3]兰州大学第二临床医学院,兰州730030

出　　处：《中华神经医学杂志》2021年第2期170-176,共7页Chinese Journal of Neuromedicine

基　　金：宁夏回族自治区科学技术厅重点研发项目(2018BEG03021)。

摘　　要：目的探讨影响前交通动脉(ACoA)破裂动脉瘤患者预后的相关因素。方法回顾性收集宁夏医科大学总医院神经外科自2014年1月至2020年1月收治的309例ACoA破裂动脉瘤患者的临床资料(术前资料包括年龄、性别、吸烟史、高血压史、Hunt-Hess分级、Fisher分级、动脉瘤大小和载瘤动脉痉挛等,术后资料包括肺炎、颅内感染、脑疝、动脉瘤复发或破裂再出血、迟发性脑缺血等),并以改良Rankin量表评估患者随访6个月的预后。应用单因素分析及多因素Logistic回归分析筛选患者预后的独立影响因素,并构建出术前模型(包括术前出现的独立危险因素)和术后模型(包括整个治疗过程中出现的独立危险因素),进一步以术前、术后模型中展示的独立危险因素为变量,结合受试者工作特征(ROC)曲线分析模型对患者预后的预测价值。结果309例ACoA破裂动脉瘤患者中,264例(85.4%)预后良好,45例(14.6%)预后不良。(1)单因素分析显示,预后良好组与预后不良组在吸烟史、高血压史、Hunt-HessⅣ~Ⅴ级、FisherⅣ级、宽颈动脉瘤、载瘤动脉痉挛、动脉瘤破裂再出血、肺炎、颅内感染、脑疝、迟发性脑缺血以及术后腰大池持续引流的比例方面差异均有统计学意义(P<0.05)。(2)多因素Logistic回归分析显示,患者预后的独立危险因素为Hunt-HessⅣ~Ⅴ级(OR=24.198,P=0.000,95%CI:4.288~136.559)、FisherⅣ级(OR=4.792,P=0.044,95%CI:1.040~22.079)、载瘤动脉痉挛(OR=12.136,P=0.005,95%CI:2.121~69.426)、肺炎(OR=8.177,P=0.018,95%CI:1.438~46.506)、脑疝(OR=147.042,P=0.002,95%CI:6.386~3385.519)和迟发性脑缺血(OR=606.720,P=0.000,95%CI:52.288~7040.088),独立保护因素为术后腰大池持续引流(OR=0.072,P=0.050,95%CI:0.005~1.000)。(3)ROC曲线分析显示,以Hunt-HessⅣ~Ⅴ级、FisherⅣ级和载瘤动脉痉挛为变量的术前模型的曲线下面积为0.870(95%CI:0.82~0.93,P=0.000),以术前模型的变量及肺炎、迟发性脑缺血�Objective To explore the related factors for clinical prognoses of ruptured anterior communicating artery(ACoA)aneurysms.Methods A retrospective study was performed on the clinical data of 309 patients with ruptured ACoA aneurysms admitted to our hospital from January 2014 to January 2020.The preoperative data included age,gender,smoking history,hypertension,Hunt-Hess grading,Fisher grading,sizes of aneurysms,and spasm of parent artery;and the postoperative data included pneumonia,intracranial infection,cerebral hernia,recurrence and re-hemorrhage of aneurysms,and delayed cerebral ischemia.Clinical prognoses were assessed by modified Rankin scale(mRS).Univariate analysis and multivariate Logistic regression analysis were used to determine the independent risk factors for clinical prognoses.Preoperative model(independent risk factors appeared before surgery)and postoperative model(independent risk factors appeared during the whole treatment process)were constructed;based on these Logistic models,the preoperative and postoperative independent risk factors were concluded.Independent risk factors presented in the preoperative and postoperative models were used as variables to analyze the predictive value of the models by receiver operating characteristic(ROC)curve.Results Among 309 patients,264(85.4%)had good prognosis and 45(14.6%)had poor prognosis.(1)Univariate analysis showed that significant differences were noted in proportion of smoking patients,and patients with hypertension,Hunt-Hess grading IV-V,Fisher grading IV,wide-necked aneurysm,re-hemorrhage of aneurysms,cerebral vasospasm,pneumonia,intracranial infection,cerebral hernia,delayed cerebral ischemia,and postoperative lumbar cistern drainage between good prognosis group and poor prognosis group(P<0.05).(2)Multivariate Logistic regression analysis showed that Hunt-Hess gradingⅣ-V(OR=24.198,P=0.000,95%CI:4.288-136.559),Fisher gradingⅣ(OR=4.792,P=0.044,95%CI:1.040-22.079),spasm of parent artery(OR=12.136,P=0.005,95%CI:2.121-69.426),pneumonia(OR=8.177,P=0

关 键 词：颅内动脉瘤 破裂动脉瘤 前交通动脉 临床预后 影响因素 

分 类 号：R743.4[医药卫生—神经病学与精神病学]