不同方式治疗破裂动脉瘤的临床疗效及预后不良危险因素分析  

Clinical efficacy of different methods in the treatment of anterior circulation ruptured intracranial aneurysms and risk factors of prognosis

作　　者：王涛 陈节[2] 文立利 张彬[1] 王金陵 张子军[2] WANG Tao;CHEN Jie;WEN Li-li(Stroke Center,Tongling People's Hospital,Tongling Anhui 244000,China;Department of Neurosurgery,Tongling People's Hospital,Tongling Anhui 244000,China;Department of Neurosurgery,Eastern Theater General Hospital,Nanjing Jiangsu 210002,China)

机构地区：[1]铜陵市人民医院卒中中心,安徽铜陵244000 [2]铜陵市人民医院神经外科,安徽铜陵244000 [3]中国人民解放军东部战区总医院神经外科,江苏南京210002

出　　处：《临床和实验医学杂志》2022年第18期1974-1978,共5页Journal of Clinical and Experimental Medicine

基　　金：2020年安徽高校自然科学研究项目(编号:KJ2020A0970)。

摘　　要：目的比较开颅夹闭术与介入栓塞术治疗前循环破裂动脉瘤性蛛网膜下腔出血(aSAH)的临床疗效,并分析预后不良的危险因素。方法将2018年1月至2021月1月铜陵市人民医院(n=63)和东部战区总医院(n=57)神经外科收治的120例aSAH患者纳入本次回顾性研究。根据接受的手术不同将患者分为夹闭组(n=60)与介入组(n=60)。比较两组患者手术、住院时间、并发症发生率;根据术后6个月的GOS评分将患者分为预后不良组(n=33)和预后良好组(n=87),用单因素分析和多因素Logistic回归分析aSAH患者预后不良的危险因素。结果介入组患者的手术时间和住院时间分别为(2.30±0.28)h、(9.20±5.30)d,均较夹闭组[(2.85±0.32)h、(13.00±6.10)d]明显缩短,介入组并发症发生率为18.36%,较夹闭组(36.67%)显著下降,差异均有统计学意义(P<0.05)。预后不良组和预后良好组在年龄、高血压、冠心病、饮酒、术前脑积水、Hunt-Hess分级、CT-Fisher分级、动脉瘤数量、发病至手术时间、栓塞程度、手术方式这11个因素方面差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,年龄≥60岁、有高血压、Hunt-Hess分级4~5级、CT-Fisher分级3~4级、动脉瘤多发、发病至手术时间≥4 d是aSAH患者预后不良的独立危险因素,而完全栓塞或瘤颈残留为保护因素。结论血管内介入术治疗aSAH的近期疗效优于开颅夹闭术,年龄≥60岁、有高血压、Hunt-Hess分级4~5级、CT-Fisher分级3~4级、动脉瘤多发、发病至手术时间≥4 d是aSAH患者术后预后不良的独立危险因素,而完全栓塞或瘤颈残留为保护因素。Objective To compare the clinical efficacy of craniotomy clipping and interventional embolization in the treatment of aneurysmal subarachnoid hemorrhage(aSAH)with ruptured anterior circulation,and to analyze the risk factors of poor prognosis.Methods A total of 120 patients with aSAH admitted to the Department of Neurosurgery of Tongling People's Hospital(63 cases)and Eastern Theater General Hospital(57 cases)from January 2018 to January 2021 were enrolled in this retrospective study and were divided into clamp group(n=60)and interventional group(n=60)according to different surgical methods.The operation time and hospital stay,the incidence of complications were compared between the two groups.According to the GOS score of 6 months after operation,the patients were divided into two groups with poor prognosis(n=33)and good prognosis(n=87).Univariate analysis and multivariate Logistic regression were used to analyze the risk factors of poor prognosis in aSAH patients.Results The operation time and hospital stay in the intervention group were(2.30±0.28)h and(9.20±5.30)d,respectively,which were significantly shorter than those in the clamp group[(2.85±0.32)h and(13.00±6.10)d],the incidence of complications in the intervention group was 18.33%,which was much lower than that in the clamping group(36.67%),the differences were statistically significant(P<0.05).There were significant differences between poor prognosis group and good prognosis group on age,hypertension,coronary heart disease,drinking,preoperative hydrocephalus,Hunt-Hess grade,CT-Fisher grade,number of aneurysms,time from onset to operation,degree of embolization and mode of operation.Multivariate Logistic regression analysis showed that age≥60 years old,hypertension,Hunt-Hess grade 4-5,CT-Fisher grade 3-4,multiple aneurysms,time from onset to operation≥4 days were independent risk factors for poor prognosis of aSAH patients,while complete embolization or neck residue were protective factors.Conclusion Compared with clipping,endovascular interventio

关 键 词：前循环破裂动脉瘤 蛛网膜下腔出血 开颅夹闭 介入治疗 预后 

分 类 号：R743.35[医药卫生—神经病学与精神病学]