未破裂前交通动脉瘤术后患者认知功能障碍的影响因素分析  

Analysis of the influencing factors of cognitive dysfunction in patients with unruptured anterior communicating aneurysm after surgery

作　　者：马宁[1] 冯欣 杨柳[1] 彭飞 王宏勤 王大明[2] 赵元立[4] 刘爱华[3] Ma Ning;Feng Xin;Yang Liu;Peng Fei;Wang Hongqin;Wang Daming;Zhao Yuanli;Liu Aihua(Department of Neurosurgery,the First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Neurosurgery,Beijing Hospital,National Center of Gerontology,Beijing 100730,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Neurosurgical Institute,Beijing 100070,China)

机构地区：[1]山西医科大学第一医院神经外科,太原030001 [2]北京医院神经外科国家老年医学中心,北京100730 [3]北京市神经外科研究所,北京100070 [4]首都医科大学北京天坛医院神经外科,北京100070

出　　处：《中华解剖与临床杂志》2021年第3期282-286,共5页Chinese Journal of Anatomy and Clinics

基　　金：国家自然科学基金(81771233);北京"登峰"人才培养计划(DFL20190501);首都卫生发展专项项目(2018-2-2041);北京市科技计划课题(Z181100009618035)。

摘　　要：目的探讨未破裂前交通动脉瘤术后患者出现认知功能障碍的影响因素。方法回顾性分析2015年1月—2017年12月北京天坛医院、山西医科大学第一医院、北京医院收治的149例未破裂前交通动脉瘤患者的临床病例资料,其中男85例、女64例,年龄18~65岁;小型动脉瘤69例,中大型动脉瘤80例。149例患者中,经显微外科手术夹闭治疗77例,血管内介入栓塞治疗72例。应用认知功能电话问卷修订版功能量表(TICS-m)评价患者术后远期认知功能情况,以TICS-m≤27分为认知功能障碍。采用单因素和多因素COX回归分析方法,分析术后患者出现认知功能障碍的影响因素。结果149例患者中109例完成了认知功能的评价,认知功能正常100例,认知功能障碍9例。单因素分析结果显示,术后认知功能正常和障碍者间未破裂前交通动脉瘤的大小和术后继发脑梗死的差异均有统计学意义(P值均<0.05);多因素COX回归分析显示,术后继发脑梗死(风险比=11.889,95%可信区间1.144~123.52,P<0.05)和患者的受教育程度(风险比=0.195,95%可信区间0.048~0.791,P<0.05)是术后患者发生认知功能障碍的独立影响因素。结论未破裂前交通动脉瘤术后患者发生脑梗死和患者的受教育程度可能会导致患者发生认知功能障碍。Objective This study aims to explore the influencing factors of cognitive dysfunction in patients with unruptured anterior communicating aneurysm after surgical treatment.Methods A retrospective analysis was performed on the clinical data of 149 unruptured anterior communicating aneurysm patients in three hospitals,which were Beijing Tiantan Hospital,the First Hospital of Shanxi Medical University,and Beijing Hospital,from January 2015 to December 2017.The modified Telephone Interview for Cognitive Status(TICS-m)was used to evaluate the patients'long-term postoperative cognitive function after surgical clipping and interventional embolization.TICS-m<27 point was defined as cognitive dysfunction.Univariate and multivariate COX regression analyses were conducted to analyze the related influencing factors of postoperative patients with cognitive dysfunction.Results Among the 149 patients,109 completed the cognitive function evaluation,of which 100 had normal cognitive function and 9 had cognitive dysfunction.Univariate analysis showed that there were statistically significant differences in the sizes of unruptured anterior communicating aneurysm and postoperative secondary cerebral infarction between patients with normal congnitive function and those with dysfunction(all P values<0.05).Multivariate COX regression analysis indicated that postoperative cerebral infarction(hazard ratio=11.889,95%confidence interval 1.144-123.52,P<0.05)and education level(hazard ratio=0.195,95%confidence interval 0.048-0.791,P<0.05)were independent factors that affected the development of cognitive dysfunction in these patients.Conclusions The occurrence of postoperative cerebral infarction and the education level of the patients with unruptured communicating aneurysm might lead to cognitive dysfunction after treatment.

关 键 词：颅内动脉瘤 认知功能障碍 影响因素 

分 类 号：R651.12[医药卫生—外科学]