摘要
目的颅内动脉瘤是严重危害人类生命的一种疾病,具有较高患病率、致残率及致死率,介入栓塞及开颅夹闭术是临床常用治疗方式,但部分患者术后可遗留不同程度的神经功能障碍,不利于患者预后,因此寻求导致患者不良预后的危险因素,并予以有效干预尤为重要。本研究旨在探讨影响颅内动脉瘤介入栓塞或开颅夹闭术患者预后的相关因素。方法选取许昌市第二人民医院2016-01-01-2018-06-01收治的106例颅内动脉瘤患者为研究对象,按治疗方式不同分为介入栓塞组和开颅夹闭术组,各53例。记录两组预后情况,并分析影响患者预后的危险因素。结果介入栓塞组预后不良13例,占24.53%;开颅夹闭术组16例,占30.19%,χ^2=0.427,P=0.513。单因素分析结果显示,Fisher分级(χ^2=4.325,P=0.016)、手术时机(χ^2=2.441,P=0.016)、Hunt-Hess分级(χ^2=14.624,P<0.001)、瘤体长径与瘤颈宽度比值(AR)(χ^2=3.310,P=0.001)及高血压(χ^2=8.898,P=0.003)是影响介入栓塞术患者预后的因素;年龄(χ^2=5.721,P=0.007)、Fisher分级(χ^2=6.148,P=0.013)、手术时机(χ^2=2.211,P=0.027)、Hunt-Hess分级(χ^2=13.545,P<0.001)、高血压(χ^2=6.173,P=0.013)及AR(χ^2=18.707,P<0.001)是影响开颅夹闭术患者预后的因素。Logistic多因素分析结果显示,Fisher分级3~4级、手术时机中和晚期、Hunt-Hess分级Ⅲ~Ⅳ级、AR≤2.0及高血压是导致介入栓塞术患者预后不良的危险因素,均P<0.05;年龄≥60岁、Fisher分级3~4级、手术时机中和晚期、Hunt-Hess分级Ⅲ~Ⅳ级、高血压及AR≤2.0是导致开颅夹闭术患者预后不良的危险因素,均P<0.05。结论颅内动脉瘤经介入栓塞或开颅夹闭术治疗后预后受多种因素影响,故临床应根据患者实际情况合理选用手术方式,以改善患者预后。
OBJECTIVE To investigate the influencing factors for prognosis of intracranial aneurysm patients with interventional embolization or craniotomy clipping.METHODS The clinical data of 106 patients with intracranial aneurysm in Second People’s Hospital of Xuchang from January 1,2016 to June 1,2018 were retrospectively analyzed.They were divided into interventional embolization group and craniotomy clipping group by treatment methods,with 53 cases in each group.RESULTS There were 13 cases with poor prognosis in the embolization group and 16 cases in the craniotomy group,accounting for 24.53%and 30.19%,χ^2=0.427,P=0.513.Univariate results showed Fisher’s grading(χ^2=4.325,P=0.016),timing of surgery(χ^2=2.441,P=0.016),Hunt-Hess classification(χ^2=14.624,P<0.001),AR(χ^2=3.310,P=0.001),hypertension(χ^2=8.898,P=0.003)were the factors affecting the prognosis of patients after interventional embolization.Age(χ^2=5.721,P=0.007),Fisher classification(χ^2=6.148,P=0.013),surgery Timing(χ^2=2.211,P=0.027),Hunt-Hess classification(χ^2=13.545,P<0.001),hypertension(χ^2=6.173,P=0.013)and AR(χ^2=18.707,P<0.001)were the he prognostic factors of craniotomy.Logistic multivariate analysis showed that Fisher’s grade(grade 3-4),timing of surgery(medium and advanced),Hunt-Hess gradeⅢ-Ⅳ,AR≤2.0,hypertension were risk factors for poor prognosis of interventional embolization(all P<0.05).Age≥60 years,Fisher grade 3-4,midterm and late surgery,Hunt-Hess gradeⅢ-Ⅳ,hypertension and AR≤2.0 were the prognosis of craniotomy risk factors(all P<0.05).CONCLUSIONS The prognosis of intracranial aneurysm treated by interventional embolization or craniotomy clipping is affected by many factors.Therefore,it is necessary to select surgical procedure based on patients’actual situations,so as to improve the prognosis of patients.
作者
王高强
徐文中
WANG Gao-qiang;XU Wen-zhong(Department of Neurosurgery,Second People's Hospital of Xuchang,Xuchang 461000,P.R.China)
出处
《社区医学杂志》
2020年第3期174-178,共5页
Journal Of Community Medicine
关键词
颅内动脉瘤
介入栓塞
开颅夹闭术
预后
危险因素
intracranial aneurysm
interventional embolization
craniotomy clipping
prognosis
influencing factors
