老年高级别颅内动脉瘤患者手术预后的影响因素研究  

Risk factors for the outcomes in elderly advanced intracranial aneurysm patients

作　　者：于建博 钱宝[1] 刘婉姣 王廉[1] 王文博 李艳丽[1] 姜状 张敏 孙丽芳 Yu Jianbo;Qian Bao;Liu Wanjiao;Wang Lian;Wang Wenbo;Li Yanli;Jiang Zhuang;Zhang Min;Sun Lifang(Department of Neurosurgery,Jiamusi Central Hospital,Jiamusi 154002,Heilongjiang Province,China)

机构地区：[1]佳木斯市中心医院神经外科,154002

出　　处：《中华老年心脑血管病杂志》2022年第5期523-526,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的 分析老年高级别颅内动脉瘤患者手术预后的影响因素。方法 回顾性分析2019年6月~2021年6月我院神经外科收治的老年高级别颅内动脉瘤患者218例临床资料,所有患者均顺利完成外科手术治疗,依据患者术后3个月的格拉斯哥预后评分(GOS)分为预后不良组60例(GOS 1~3分)和预后良好组158例(GOS 4~5分)。比较2组一般临床资料,采用多因素logistic回归分析老年高级别颅内动脉瘤患者手术预后不良的危险因素。结果 预后不良组年龄≥70岁、吸烟、颅内动脉瘤家族史、入院收缩压≥140 mm Hg(1 mm Hg=0.133 kPa)、Claassen分级3~4级、Hurt-Hess分级Ⅴ级、后循环颅内动脉瘤、颅内动脉瘤直径≥15 mm、多发、颅内血肿量≥50 ml、手术时机≥3 d、脑室出血、白细胞计数≥20×10;/L比例明显高于预后良好组,TC、TG、纤维蛋白原、血红蛋白水平明显低于预后良好组,差异有统计学意义(P<0.05,P<0.01)。年龄≥70岁(OR=1.737,95%CI:2.397~4.184,P=0.024)、Claassen分级3~4级(OR=3.522,95%CI:2.025~3.987,P=0.019)、Hurt-Hess分级Ⅴ级(OR=2.942,95%CI:2.492~4.095,P=0.031)、颅内血肿量≥50 ml(OR=3.673,95%CI:2.017~4.812,P=0.001)、手术时机≥3 d(OR=2.301,95%CI:2.485~4.128,P=0.028)、脑室出血(OR=3.012,95%CI:2.684~4.348,P=0.018)为老年高级别颅内动脉瘤患者手术预后不良的危险因素。结论 年龄、Claassen分级、Hurt-Hess分级、颅内血肿量、手术时机、脑室出血为老年高级别颅内动脉瘤患者手术预后不良的危险因素,临床应给予高危患者积极监测和有效措施改善预后。Objective To analyze the risk factors for the outcomes in elderly advanced intracranial aneurysm patients.Methods The clinical data of 218 elderly advanced intracranial aneurysm patients admitted to our hospital from June 2019 to June 2021 were retrospectively analyzed.The patients who underwent successful surgery were divided into poor outcome group(n=60) and good outcome group(n=158) according to their Glasgow outcome score.Their general clinical data were compared.The risk factors for the poor outcome in elderly advanced intracranial aneurysm patients after operation were analyzed by multivariate logistic regression analysis.Results The ratios of age≥70 years, history of smoking and intracranial aneurysm, SBP on admission≥140 mm Hg, Claassen grading 3-4,Hurt-Hess grading V,diameter of posterior circulation intracranial aneurysm and intracranial aneurysm≥15 mm, multiple intracranial hematoma volume≥50 ml, operation time≥3 days, intraventricular hemorrhage, WBC≥20×10^(9)/L were significantly higher while the serum levels of TC,TG, fibrinogen and hemoglobin were significantly lower in poor outcome group than in good outcome group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that age≥70 years, Claassen grading 3-4,Hurt-Hess grading Ⅴ,intracranial hematoma volume≥50 ml, operation time≥3 days and ventricular hemorrhage were risk factors for the poor outcome in elderly advanced intracranial aneurysm patients after operation(OR=1.737,95%CI:2.397-4.184,P=0.024;OR=3.522,95%CI:2.025-3.987,P=0.019;OR=2.942,95%CI:2.492-4.095,P=0.031;OR=3.673,95%CI:2.017-4.812,P=0.001;OR=2.301,95%CI:2.485-4.128,P=0.028;OR=3.012,95%CI:2.684-4.348,P=0.018).Conclusion Age, Claassen grading, Hurt-Hess grading, intracranial hematoma volume, operation time and ventricular hemorrhage are the risk factors for the poor outcome in elderly advanced intracranial aneurysm patients.Active and effective measures should thus be taken to improve their outcomes.

关 键 词：颅内动脉瘤 手术后期间 纤维蛋白原 血肿 血红蛋白类 

分 类 号：R651.12[医药卫生—外科学]