颅内破裂动脉瘤治疗策略与预后影响因素:单中心1572例倾向性评分匹配分析  

Therapeutic strategies and prognostic factors of patients with ruptured intracranial aneurysms based on propensity score matching analysis:a single-center retrospective cohort study of 1572 cases

作　　者：孙奇 王翼 边世春 安学锋 秦杰 韦可 蔡彦超 雷颉 杨铭 黄河 马廉亭 SUN Qi;WANG Yi;BIAN Shi-chun;AN Xue-feng;QIN Jie;WEI Ke;CAI Yan-chao;LEI Jie;YANG Ming;HUANG He;MALian-ting(Department of Neurosurgery,General Hospital of Central Theater Command,Wuhan 430070,China;Department of Neurosurgery,The 985th Hospital of Joint Logistic Support Force,Taiyuan 030001,China)

机构地区：[1]中部战区总医院神经外科,武汉430070 [2]联勤保障部队第九八五医院神经外科,太原030001

出　　处：《中国临床神经外科杂志》2023年第12期673-677,共5页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨显微手术夹闭与血管内栓塞治疗颅内破裂动脉瘤的预后及其影响因素,为颅内破裂动脉瘤的治疗提供更多参考。方法回顾性分析2013年6月至2023年6月收治的1572例颅内破裂动脉瘤的临床资料,其中显微手术夹闭407例(夹闭组),血管内栓塞1165例(栓塞组)。出院时按GOS评分评估预后,其中1~3分为预后不良,4~5分为预后良好。结果栓塞组出院时预后良好率(88.3%)明显高于夹闭组(75.4%;P<0.05),而且栓塞组住院时间(14 d;IQR 11~18 d)明显少于夹闭组(16d;IQR 13~25 d;P<0.05);但是两组病人术前Hunt-Hess分级、颅内血肿、动脉瘤部位存在显著差异(P<0.05)。通过倾向性评分匹配(PSM)后两组各纳入336例,分析结果显示栓塞组出院时预后良好率(81.0%)与夹闭组(81.8%)无统计学差异(P>0.05),但栓塞组住院时间(10 d;IQR 8~11 d)仍明显少于夹闭组(16 d;IQR 13~22 d;P<0.05)。多因素logistic回归分析结果显示,年龄≥60岁、发病时间>72 h、合并颅内血肿、术前Hunt-Hess分级Ⅳ~Ⅴ是颅内破裂动脉瘤预后不良的独立危险因素(P<0.05)。夹闭组共随访307例,动脉瘤复发率为1.9%;栓塞组共随访1029例,动脉瘤复发率为7.3%;夹闭组动脉瘤复发率明显低于栓塞组(P<0.05);PSM分析后两组各纳入275例,夹闭组动脉瘤复发率(2.2%)仍明显低于栓塞组(6.6%;P<0.05)。结论显微手术夹闭与血管内栓塞治疗颅内破裂动脉瘤的预后均较好,栓塞治疗住院时间较短、复发率较高,临床应根据病人病情个体化选择。病人年龄、发病时间、颅内血肿、Hunt-Hess分级为病人预后的独立影响因素,临床上应加以重视。Objective To explore the efficacy of microsurgical clipping and endovascular embolization for patients with ruptured intracranial aneurysms(RIA)and the RIA patients'prognotic factors,in order to provide more reference for the treatment of RIA.Methods The clinical data of 1572 patients with RIA,of whom 407 patients underwent microsurgical clipping(clipping group)and 1165 patients underwent endovascular embolization(embolization group),from June 2013 to June 2023 were retrospectively analyzed.The prognoses of these patients were evaluated by the GOS score at discharge,with a GOS score of 1~3 as poor prognosis and a GOS score of 4~5 as good prognosis.Results The rate of good prognosis in the embolization group(88.3%)was significantly higher than that(75.4%)in the clipping group(P<0.05),and the length of hospital stay in the embolization group(14 d;IQR 11~18 d)was significantly shorter than that(16 d;IQR 13~25 d)in the clipping group(P<0.05).However,there were significant differences in preoperative Hunt-Hess grade,intracranial hematoma and aneurysm site between the two groups(P<0.05).After propensity score matching(PSM)analysis,336 patients were included in each of the two groups.The PSM analysis results showed that there was no significant difference in the rate of good prognosis at discharge between the embolization group(81.0%)and the clipping group(81.8%;P>0.05),but the length of hospital stay in the embolization group(10 d;IQR 8~11 d)was significantly shorter than that(16 d;IQR 13~22 d)in the clipping group(P<0.05).Multivariate logistic regression analysis showed that age≥60 years,onset time>72 h,intracranial hematoma and preoperative Hunt-Hess gradeⅣ~Ⅴwere independent risk factors for poor prognoses of patients with RIA(P<0.05).In the clipping group,307 patients were followed up,and the recurrence rate was 1.9%.In the embolization group,1029 patients were followed up,and the recurrence rate was 7.3%.The recurrence rate in the clipping group was significantly lower than that in the embolization group(P<0.

关 键 词：颅内破裂动脉瘤 显微夹闭术 血管内栓塞 预后 危险因素 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]