血流动力学参数预测颅内动脉瘤夹闭术中破裂的价值  

Value of Hemodynamic Parameters in Prediction of Intracranial Aneurysm Rupture during Clipping Surgery

作　　者：袁璞 徐瀚 聂文臣 高明明 朱宗锦 刘保华 刘厚强 YUAN Pu;XU Han;NIE Wen-chen;GAO Ming-ming;ZHU Zong-jin;LIU Bao-hua;LIU Hou-qiang(Department of Neurosurgery,Suqian Hospital Affiliated to Xuzhou Medical University,Suqian 223800,Jiangsu,China)

机构地区：[1]徐州医科大学附属宿迁医院神经外科,江苏宿迁223800

出　　处：《中国现代手术学杂志》2021年第5期376-379,共4页Chinese Journal of Modern Operative Surgery

基　　金：宿迁市指导性科技计划项目(Z20200102)。

摘　　要：目的探讨血流动力学参数预测颅内动脉瘤夹闭术中破裂的价值。方法选取2015年1月至2019年1月收治的96例颅内动脉瘤患者,其中夹闭术中颅内动脉瘤破裂患者48例(破裂组),术中动脉瘤未破裂患者48例(未破裂组)。收集患者术前CT血管成像图,采用流体力学工作站分析血流动力学指标。采用Logistic回归分析夹闭术中颅内动脉瘤破裂的影响因素,受试者工作特征曲线(ROC)分析血流动力学参数预测夹闭术中动脉瘤破裂的价值。结果破裂组患者瘤体颈比值、壁面切应力(WSS)和剪切震荡指数(OSI)均明显高于未破裂组,差异有统计学意义(P<0.05)。瘤体颈比值、WSS和OSI是夹闭术中颅内动脉瘤破裂的独立影响因素(P<0.05)。OSI、WSS和瘤体颈比值预测动脉瘤破裂的ROC曲线下面积分别为0.880、0.821、0.732,具有较好的预测价值,三者联合时AUC可提高至0.912。结论血流动力学参数WSS和OSI对预测夹闭术中颅内动脉瘤破裂有一定价值。Objective To explore the value of hemodynamic parameters in predicting the rupture of intracranial aneurysm during clipping operation.Methods From January 2015 to January 2019,48 patients with ruptured intracranial aneurysm(ruptured group)and 48 patients without ruptured aneurysm(unruptured group)were enrolled and analyzed retrospectively.The pre-operative images of CT angiography were collected and the hemodynamic indexes were analyzed by the hydrodynamics workstation.Logistic regression was used to analyze the influencing factors of intracranial aneurysm rupture during clipping operation,and receiver operating characteristic curve(ROC)was applied to analyze the value of hemodynamic parameters in predicting aneurysm rupture.Results The tumor neck ratio,wall shear stress(WSS)and oscillatory shear index(OSI)of the ruptured group were all higher than those of the unruptured group,and three indices were related to intracranial aneurysm rupture during clipping operation(P<0.05).Multivariated logistic regression analysis showed that tumor neck ratio,WSS and OSI were the independent factors of intracranial aneurysm rupture during clipping operation.The area under the ROC curve of OSI,WSS and tumor neck ratio was 0.880,0.821 and 0.732 respectively in predicting of aneurysm rupture,which indicated that these indices had good predictive value.When the three indices combined,AUC increased to 0.912.Conclusion The hemodynamic parameters of WSS and OSI are valuable for the prediction of intracranial aneurysm rupture during clipping operation.

关 键 词：颅内动脉瘤 破裂 血流动力学 预测 

分 类 号：R739.41[医药卫生—肿瘤]