显微手术夹闭治疗前循环破裂动脉瘤的预后影响因素  

Prognostic factors of anterior circulation ruptured aneurysms treated by microsurgical clamping

作　　者：陈泽鑫[1,2] 王育胜[2] 林楚纯[2] 蔡跃豪 袁军[3] Chen Zexin;Wang Yusheng;Lin Chuchun;Cai Yuehao;Yuan Jun(Medical College,Shantou University,Shantou 515041,China;Department of Neurosurgery,Jieyang People's Hospital,Jieyang 522000,China;Department of Neurosurgery,First Hospital,Shantou University,Shantou 515041,China)

机构地区：[1]汕头大学医学院,汕头515041 [2]揭阳市人民医院神经外科,揭阳522000 [3]汕头大学附属第一医院神经外科,汕头515041

出　　处：《国际医药卫生导报》2024年第15期2506-2510,共5页International Medicine and Health Guidance News

基　　金：广东省医学科研基金(A2024710)

摘　　要：目的探讨影响显微手术夹闭治疗前循环破裂动脉瘤预后的因素。方法回顾性选取2018年1月至2023年6月揭阳市人民医院收治的80例前循环破裂动脉瘤患者,男38例、女42例,年龄(53.28±2.81)岁,入院至手术时间(1.96±0.52)d,临床表现:剧烈头痛48例,轻度头痛31例,意识障碍26例。所有患者均行显微手术夹闭治疗,根据预后分为预后良好组与预后不良组,术后随访6个月,分析其临床资料,应用格拉斯哥预后量表(GOS)对患者预后进行评估,采用χ^(2)检验,以logistic回归方程分析影响预后的相关因素。结果80例患者均随访成功,其中预后良好59例(73.75%),预后不良21例(26.25%);两组年龄、性别、动脉瘤长径、手术时间、出血次数、入院至手术时间比较,差异均无统计学意义(均P>0.05);logistic分析结果显示,术前Hunt-Hess分级、格拉斯哥昏迷量表(GCS)评分、术后脑血管并发症、术后颅内感染、Fisher分级为影响前循环破裂动脉瘤患者预后的危险因素(均P<0.05)。结论影响显微手术夹闭治疗前循环破裂动脉瘤患者预后的因素较多,主要与术前Hunt-Hess分级、GCS评分、术后颅内感染等密切相关。Objective To explore the factors affecting the prognosis of patients with anterior circulation ruptured aneurysms treated by microsurgical clamping.Methods Eighty patients with anterior circulation ruptured aneurysms admitted to Jieyang People,s Hospital from January 2018 to June 2023 were selected,including 38 males and 42 females.They were(53.28±2.81)years old.The time from admission to surgery was(1.96±0.52)days.Clinical manifestations:48 cases had severe headache,31 cases mild headache,and 26 cases consciousness disorders.All the patients were treated by microsurgical clamping.They were followed up for 6 months after the surgery.The patients were divided to a good prognosis group and a poor prognosis group according to their prognosis.Their clinical data were analyzed.The Glasgow Outcome Scale(GOS)was used to evaluate their prognosis.The logistic regression equations were used to analyze the relevant factors affecting their prognosis.Results All the 80 patients were successfully followed up,including 59 cases(73.75%)with good prognosis and 21 cases(26.25%)with poor prognosis.There were no statistical differences between the two groups in age,gender,aneurysm diameter,operation time,number of bleedings,and time from admission to operation(all P>0.05);there were statistical differences in the rest factors between the two groups(all P<0.05).The logistic analysis results showed that preoperative Hunt-Hess classification,Glasgow Coma Scale(GCS)score,postoperative cerebrovascular complications,postoperative intracranial infection,and Fisher classification were risk factors affecting the patients'prognosis(all P<0.05).Conclusion There are many factors affecting the prognosis of patients with anterior circulation ruptured aneurysms.Their prognosis is mainly closely related to preoperative Hunt-Hess grading,GCS score,postoperative intracranial infection,etc.

关 键 词：前循环破裂动脉瘤 显微手术夹闭 预后 影响因素 

分 类 号：R651.1[医药卫生—外科学]