栓塞治疗颅内前循环破裂动脉瘤的预后影响因素分析  

Influencing factors of prognosis of embolization in the treatment of ruptured intracranial anterior circulation aneurysm

作　　者：李超 胡承俊 李强[1] LI Chao;HU Cheng-jun;LI Qiang(Department of Neurosurgery,the Second Affiliated Hospital of Hainan Medical University,Haikou 570100,Hainan,CHINA)

机构地区：[1]海南医学院第二附属医院神经外科,海南海口570100

出　　处：《海南医学》2022年第17期2199-2203,共5页Hainan Medical Journal

摘　　要：目的探讨影响颅内前循环破裂动脉瘤栓塞治疗预后的因素,以提高血管内治疗动脉瘤的疗效。方法回顾性分析海南医学院第二附属医院神经外科2016年6月至2019年6月收治的107例颅内前循环破裂动脉瘤患者的临床和动脉瘤影像学资料,术后随访患者6个月,根据格拉斯哥预后评分(GOS)评分分为预后不良组74例和预后良好组33例。对可能影响动脉瘤栓塞术预后的相关因素进行单因素分析及多因素二元Logistic回归分析。结果预后良好组和预后不良组患者的高血压病史、术前改良Fisher分级、Hunt-Hess分级以及并发症比较,差异均有统计学意义(P<0.05),但两组患者的年龄、性别、饮酒史、吸烟史及颅内动脉瘤的形态、大小、数量、部位和术后即刻栓塞程度等因素比较差异均无统计学意义(P>0.05);经多因素二元Logistic回归分析结果显示,改良Fisher分级与术后缺血性脑梗塞、脑积水等为影响预后的独立危险因素(P<0.05)。结论术前改良Fisher 3~4级及术后缺血性脑梗塞、脑积水等并发症是影响前循环破裂动脉瘤患者栓塞术预后的高危因素。Objective To explore the factors affecting the prognosis of embolization in treatment of ruptured intracranial anterior circulation aneurysm,so as to improve the efficacy of endovascular treatment of aneurysms.Methods The clinical and imaging data of 107 patients with ruptured intracranial anterior circulation aneurysms treated in the Department of Neurosurgery,the Second Affiliated Hospital of Hainan Medical University from June 2016 to June 2019 were analyzed retrospectively.All patients were followed up for 6 months after surgery.According to Glasgow Outcome Scale(GOS)score,they were divided into poor prognosis group(n=74)and good prognosis group(n=33).Univariate analysis and multivariate binary Logistic regression analysis were performed on the factors that might affect the prognosis of aneurysm embolization.Results There were statistically significant differences in hypertension history,preoperative modified Fisher grade,Hunt-Hess grade,and complications between the good prognosis group and the poor prognosis group(P<0.05).However,there were no significant differences in age,gender,drinking history,smoking history,morphology,size,number,location,and immediate postoperative embolization degree of intracranial aneurysms between the two groups(P>0.05).The results of multivariate binary logistic regression analysis showed that the improved Fisher grade,postoperative ischemic cerebral infarction,and hydrocephalus were independent risk factors affecting prognosis(P<0.05).Conclusion Preoperative modified Fisher grade 3-4 and postoperative complications such as ischemic cerebral infarction and hydrocephalus are high risk factors affecting the prognosis of patients with ruptured anterior circulation aneurysm after embolization.

关 键 词：前循环破裂动脉瘤 栓塞治疗 预后 影响因素 

分 类 号：R739.41[医药卫生—肿瘤]