支架辅助弹簧圈栓塞治疗颅内动脉瘤术后支架内血栓发生的影响因素  

Influence factors on the occurrence of intra stent thrombosis after stent-assisted coil embolization for intracranial aneurysms

作　　者：刘光普[1] 谢成金[1] 张立 李劲松[1] LIU Guang-pu;XIE Cheng-jin;ZHANG Li;LI Jin-song(Department of Neurosurgery,Meizhou People’s Hospital,Meizhou Guangdong 514000,China)

机构地区：[1]梅州市人民医院神经外科,广东梅州514000

出　　处：《局解手术学杂志》2021年第5期412-416,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：广东省医学科学技术研究基金项目(A2017s03579)。

摘　　要：目的探讨支架辅助弹簧圈栓塞(SACE)治疗颅内动脉瘤术后发生支架内血栓的影响因素,并分析支架内血栓对患者神经预后的影响。方法回顾性分析我院神经外科收治的84例行SACE治疗的颅内动脉瘤患者的临床资料,根据术后是否发生支架内血栓将其分为血栓组(7例)和无血栓组(77例),收集患者基线资料和围术期数据,采用Logistic回归分析影响SACE治疗颅内动脉瘤术后支架内血栓发生的危险因素,随访患者神经预后情况,分析支架内血栓形成对神经预后的影响。结果血栓组患者年龄大于无血栓组(P<0.05),收缩压、合并糖尿病的比例、支架类型为LEO的比例、置入支架数量为3个的比例、支架直径<3 mm的比例、手术时间≥3 h的比例、术中肝素化不充分的比例、术后抗凝不充分的比例、术前FPG、白细胞计数高于无血栓组(P<0.05)。Logistic回归分析结果显示,支架类型为LEO(OR=1.844,95%CI1.732~1.931)、支架直径<3 mm(OR=2.298,95%CI2.105~2.356)、手术时间≥3 h(OR=1.749,95%CI1.623~1.895)、术后抗凝不充分(OR=1.516,95%CI1.438~1.665)是SACE术后发生支架内血栓的危险因素(P<0.01)。84例患者失访3例,其余81例患者中,预后良好60例,预后不良21例,血栓组预后不良发生率高于无血栓组(P<0.05)。结论SACE术后具有一定支架内血栓的风险,支架内血栓的发生可恶化患者神经预后。支架类型、支架直径、手术时间、抗凝管理均与SACE术后支架内血栓的发生有关。Objective To explore the influence factors of intra stent thrombosis after stent-assisted coil embolization(SACE)for intracranial aneurysms,and to analyze the influence of intra stent thrombosis on the neurological prognosis of patients.Methods The clinical data of 84 patients with intracranial aneurysm treated with SACE in the neurosurgery department of our hospital were retrospectively analyzed.According to the occurrence of intra stent thrombosis after surgery,these patients were divided into the thrombosis group(7 cases)and the no thrombosis group(77 cases).Baseline data and perioperative data of the patients were collected to analyze the risk factors influencing the occurrence of intra stent thrombosis after SACE treatment for intracranial aneurysm by Logistic regression analysis.The neurological prognosis of the patients was followed up to analyze the effect of intra stent thrombosis on the neurological prognosis.Results Patients in the thrombosis group were older than those in the no thrombosis group(P<0.05).Systolic blood pressure,the proportion of diabetes mellitus,the proportion of stent type for LEO,the proportion of three stents were placed,the proportion of stent diameter<3 mm,the proportion of operation time≥3 hours,the proportion of intraoperative heparinization inadequate,the proportion of insufficient postoperative anticoagulation,preoperative FPG,and white blood cell count in the thrombosis group were higher than those of the no thrombosis group(P<0.05).Logistic regression analysis results showed that stent type for LEO(OR=1.844,95%CI:1.732~1.931),stent diameter<3 mm(OR=2.298,95%CI:2.105~2.356),operation time≥3 hours(OR=1.749,95%CI:1.623~1.895),insufficient postoperative anticoagulation(OR=1.516,95%CI:1.438~1.665)were the risk factors for intra stent thrombosis after SACE(P<0.01).Three of the 84 patients were lost to follow-up.Among the remaining 81 patients,60 patients had a good prognosis and 21 patients had a poor prognosis.The incidence of poor prognosis in the thrombosis group was highe

关 键 词：支架辅助弹簧圈栓塞 颅内动脉瘤 支架内血栓 支架类型 支架直径 手术时间 抗凝管理 

分 类 号：R543.5[医药卫生—心血管疾病] R605[医药卫生—内科学]