颅内动脉瘤夹闭术后迟发性脑梗死危险因素分析  

Risk factors for delayed cerebral infarction after intracranial aneurysm clipping

作　　者：苏俊 黄豪 辛元君 吴欣桐 杨小林 何朝晖[1] SU Jun;HUANG Hao;XIN Yuanjun;WU Xintong;YANG Xiaolin;HE Zhaohui(Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016;Department of Neurosurgery,Nanchuan People's Hospital,Chongqing,408400,China)

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016 [2]重庆市南川区人民医院神经外科,重庆408400

出　　处：《第三军医大学学报》2021年第7期635-639,共5页Journal of Third Military Medical University

基　　金：国家自然科学基金面上项目(81870927);重庆市自然科学基金面上项目(CSTC2019jcyj-msxmX0239)。

摘　　要：目的分析颅内动脉瘤(intracranial aneurysm, IA)夹闭术后发生迟发性脑梗死(delayed cerebral infarction, DCI)的危险因素及临床意义。方法回顾性分析2015年1月至2019年12月重庆医科大学附属第一医院神经外科收治的颅内动脉瘤患者的临床资料,纳入动脉瘤夹闭术患者共480例。其中发生DCI的患者设为观察组,共42例;未发生DCI的患者设为对照组,共438例;以单因素和多因素Logistic回归分析筛选发生DCI的危险因素。结果单因素分析显示女性(P=0.029)、小动脉瘤(P=0.001)、术中动脉瘤破裂(P=0.007)及脑血管痉挛(P<0.001)是术后发生DCI的危险因素,而吸烟史(P=0.020)为其保护性因素。多因素Logistic回归分析显示小动脉瘤(P=0.002,OR=2.951,95%CI:1.478~5.893)、术中动脉瘤破裂(P=0.004,OR=7.829,95%CI:1.924~31.854)及脑血管痉挛(P<0.001,OR=5.919,95%CI:2.887~12.134)为术后DCI的独立危险因素。结论妥善处理小动脉瘤,积极预防术中动脉瘤破裂和治疗脑血管痉挛,可有效防止DCI发生,从而降低致残率,改善患者预后。Objective To analyze the risk factors and clinical significance of delayed cerebral infarction(DCI) after intracranial aneurysm(IA) clipping. Methods A retrospective analysis was performed on the clinical data of IA patients admitted to the First Affiliated Hospital of Chongqing Medical University from January 2015 to December 2019. A total of 480 patients undergoing aneurysm clipping were included. The patients with DCI were set as the observation group(n=42), and those without as the control group(n=438). The risk factors for DCI were screened by univariate and multivariate logistic regression analysis. Results Univariate analysis showed that female(P=0.029), small aneurysms(P=0.001), intraoperative aneurysm rupture(IAR)(P=0.007) and cerebral vasospasm(P<0.001) were risk factors for DCI after IA clipping, while smoking history(P=0.020) was a protective factor. Multivariate logistic regression analysis indicated that small aneurysms(P=0.002, OR=2.951, 95%CI:1.478~5.893), IAR(P=0.004, OR=7.829, 95%CI:1.924~31.854) and cerebral vasospasm(P<0.001, OR=5.919, 95%CI:2.887~12.134) were postoperative independent risk factors for DCI. Conclusion Proper treatment of small aneurysms, proactive prevention of IAR and treatment of cerebral vasospasm can prevent the occurrence of DCI effectively, and thereby reduce the disability rate and improve the prognosis of patients.

关 键 词：颅内动脉瘤 夹闭术 迟发性脑梗死 危险因素 

分 类 号：R732.21[医药卫生—肿瘤] R739.41[医药卫生—临床医学]