摘要
目的分析老年颅内破裂性动脉瘤介入术后继发脑血管痉挛(cerebral vasospasm,CVS)的危险因素,探讨围术期防治对策。方法选择2011年1月—2015年12月在我院收治的老年颅内破裂性动脉瘤介入术后继发CVS患者54例作为观察组,随机选取同期老年颅内破裂性动脉瘤介入术后未继发CVS患者60例作为对照组,比较两组临床特征、围术期医疗因素,对有统计学差异的指标采用logistic多因素分析筛查术后继发CVS的危险因素。两组随访3个月,观察近期预后。结果单因素分析显示,动脉瘤直径、吸烟和酗酒史、高血压病史、术前格拉斯哥昏迷评分(Glasgow coma score,GCS)、动脉瘤性蛛网膜下腔出血入院患者预后(prognosison admission of aneurysmal subarachnoid haemorrhage,PAASH)分级、既往动脉瘤破裂次数、术前Hunt-Hess分级、术前Fisher分级、栓塞程度、真假性动脉瘤、术后血压波动范围、介入手术时机、术后使用"3H"疗法为老年颅内破裂性动脉瘤介入术后继发CVS的影响因素。logistic多因素分析显示,动脉瘤直径≥15 mm、既往动脉瘤破裂>2次、术前Hunt-Hess分级>Ⅲ级、术前Fisher分级≥3级、非致密栓塞、假性动脉瘤、术后血压波动>30 mm Hg是老年颅内破裂性动脉瘤介入术后继发CVS的独立危险因素,早期(72 h以内)介入栓塞、术后使用"3H"疗法是其保护因素。两组术后3个月格拉斯哥预后评分分级量表显示,观察组近期预后较对照组差(P<0.05)。结论老年颅内破裂性动脉瘤介入术后继发CVS患者病死率高、总体预后差,针对患者术后继发CVS的可控危险因素实施良好的控制以改善患者预后。
cranial aneurysms in the perioperative period.Methods January 2011-December 2015 months in our hospital senile ruptured intracranial aneurysm after interventional operation of cerebral vasospasm in 54 cases of the observation group, were randomly selected for the intervention of elderly patients of ruptured intracranial aneurysms after cerebral vasospasm in 60 cases as control group, compared two groups of clinical characteristics, postoperative medical factors.There were significant differences in the indexes by Logistic regression analysis, the risk factors of cerebral vasospasm after screening.Two groups of patients were followed up for at least 3 months, and the prognosis was observed.At the same time to explore the prevention and treatment of cerebral vasospasm.Results Univariate analysis showed that the aneurysm size, for the first time the severity of bleeding and postoperative blood pressure control, smoking and drinking, pseudoaneurysm or false aneurysm cavity, preoperative aneurysm rupture times, preoperative Fisher classification, interventional operation time, preoperative GCS score, postoperative use of ＂3H＂ therapy Hunt, PAASH grade, Hess classification, aneurysm embolization degree of the two groups had significant difference.Multivariate Logistic analysis showed that the aneurysm and 15 mm, postoperative blood pressure fluctuations, 30 mmHg, aneurysm rupture, preoperative 2, Hunt Hess, grade Ⅲ, grade level Fisher=3, non dense embolism, pseudoaneurysm is a risk of cerebral vasospasm factors in elderly patients with ruptured intracranial aneurysm after interventional treatment, early （within 72 h） embolization, the use of ＂3H＂ after therapy is a protective factor.The patients in the observation group after 3 months GOS outcome scale.Results： 20 cases of grade I, grade Ⅱ in 7 cases, 12 cases of grade Ⅲ, Ⅳ in 11 cases, 4 cases of grade V, the control group of 5 cases, 6 cases of grade Ⅱ, 21 cases of grade IⅡ, Ⅳ in 18 cases, 15 cases V, the observation group prognosis is worse than that of control group （P〈0.05）.Conclusion Elderly patients with ruptured intracranial aneurysm after surgical intervention of cerebral vasospasm, the overall poor prognosis and high mortality, according to the risk of cerebral vasospasm factors in elderly patients with ruptured intracranial aneurysm after interventional deterioration of protective factors, the implementation of good control of the controllable factors to improve the prognosis of patients.
出处
《临床误诊误治》
2017年第7期70-75,共6页
Clinical Misdiagnosis & Mistherapy
基金
四川省科技支撑计划项目(2016FZ0073)
关键词
颅内动脉瘤
老年人
介入术
血管痉挛
颅内
手术后并发症
影响因素分析
Intracranial aneurysm
Aged
Interventional therapy
Vasospasm, intracranial
Postoperative complications
Root cause analysis
