摘要
目的探讨行血管内治疗的破裂颅内动脉瘤患者预后的影响因素。方法回顾性分析2012年12月至2014年12月于宁夏医科大学总医院神经外科收治的93例破裂颅内动脉瘤患者的临床资料，包括患者的年龄、性别、入院时Hunt—Hess分级、CTFisher分型、原发性高血压病史、糖尿病病史、动脉瘤的大小、动脉瘤的部位、动脉瘤是否多发、入院至手术时间、手术方式、栓塞程度、术后并发症以及血钠水平。所有病例均行血管内治疗。随访时间为18个月。采用改良的Rankin量表评分（mRS）评估患者的预后。对可能影响患者预后的因素进行单因素分析，然后将有统计学意义的因素纳入多因素L画stic回归分析，以明确影响患者预后的独立因素。结果93例患者均获随访，其中68例（73％）预后良好，25例（27％）预后不良。单因素分析结果提示，入院时Hunt-Hess分级、CTFisher分型、术后并发症以及血钠水平可能与患者的预后相关（均P〈0．05）。多因素Logistic回归分析结果显示，入院时Hunt—Hess分级Ⅲ级（OR=14．724，95％CI：1．520～142．644，P=0．020）、Hunt-Hess分级Ⅳ级（OR=99．350，95％CI：6．819～1447．563，P=0．001）以及术后并发症（OR=13．420，95％CI：3．021～59．624，P=0．001）为影响行血管内治疗的破裂颅内动脉瘤患者预后的独立危险因素。结论人院时Hunt-Hess分级和术后并发症能够影响行血管内治疗的破裂颅内动脉瘤患者的预后。
Objective To investigate the prognostic factors in endovascular treatment of ruptured intracranial aneurysms. Methods The clinical data of 93 cases of ruptured aneurysm treated by endovascular treatment at Department of Neurosurgery, General Hospital of Ningxia Medical University from December 2012 to December 2014 were retrospectively analyzed, including the patients＇age, gender, Hunt -Hess grade on admission, Fisher grade on admission, primary hypertension, diabetes, size of aneurysms, location of aneurysms, multiple anenrysms, the time between admission and operation, operation method, extent of embolism, postoperative complication and the level of blood sodium. The patients＂ outcomes were evaluated adopting the modified Rankin scale Score（mRS） at the time of 18 months post hospital discharge. Possible factors were studied using the univariate analysis, and the factors with statistical significance were further investigated with multivariate variate logistic regression analysis to determine the independent elements. Results The follow-up study was successfully conducted for all 93 cases with 68 （73%） demonstrating satisfactory outcomes and the remaining 25 cases （27%） reporting poor outcomes. The univariate analysis indicated that Hunt-Hess grade on admission, Fisher grade, postoperative complications and blood sodium level were significantly correlated with the prognosis （ P 〈 0. 05 ）. The multiple factors analysis indicated that Hunt - Hess grade Ⅲ（ OR 14. 724,95% CI 1. 520- 142. 644, P = 0. 020）, Hunt- HessgradeⅣ （ OR 99. 350,95% CI 6. 819 - 1447. 563, P = 0. 001 ） and postoperative complication （ OR 13. 420,95% CI 3. 021 - 59. 624 ,P = 0. 001 ） were the independent risk factors affecting the prognosis for endovascular treatment of ruptured intracranial aneurysms. Conclusion Hunt-Hess grade on admission and postoperative complications could significantly affect the prognosis of the patients for endovascular treatment of ruptured intracranial aneurysms.
出处
《中华神经外科杂志》
CSCD
北大核心
2017年第1期49-53,共5页
Chinese Journal of Neurosurgery
关键词
颅内动脉瘤
血管内操作
预后
危险因素
Intracranial aneurysm
Endovascular procedures
Prognosis
Risk factors
