摘要
目的探讨显微镜下行开颅夹闭前交通动脉瘤手术后迟发性脑梗死的影响因素。方法回顾性分析2020年1月~2023年7月于徐州医科大学附属医院行显微镜下开颅夹闭前交通动脉瘤手术治疗患者的临床资料。采用单因素和多因素Lo-gistic回归分析评价术后发生迟发性脑梗死的影响因素。结果在140例患者中,有13例(9.3%)患者术后出现了迟发性脑梗死。单因素分析结果显示,患者的Hunt-Hess等级评分、改良Fisher分级、术中前交通动脉瘤破裂、动脉瘤形态不规则、术中应用吲哚菁绿荧光造影、术中应用罂粟碱、术中行脑室穿刺引流等差异均有统计学意义(P<0.05)。将单因素分析中差异有统计学意义的因素进行多因素Logistic回归分析,结果显示,改良Fisher分级和术中前交通动脉瘤破裂为发生术后迟发性脑梗死的独立危险因素,而术中应用吲哚菁绿荧光造影为保护性因素(P<0.05)。结论改良Fisher分级和术中前交通动脉瘤破裂被确认为显微镜下行开颅夹闭前交通动脉瘤术后发生迟发性脑梗死的独立危险因素,而术中应用吲哚菁绿荧光造影可以有效降低术后迟发性脑梗死的发生率。
Objective To investigate the influencing factors of delayed cerebral infarction after microsurgical craniotomy clipping of anterior communicating artery aneurysms.Methods The clinical data of patients who underwent microsurgical craniotomy clipping of an-terior communicating artery aneurysms in the Affiliated Hospital of Xuzhou Medical University from January 2020 to July 2023 were retro-spectively analyzed.The influencing factors of postoperative delayed cerebral infarction were determined by univariate and multivariate Lo-gistic regression analysis.Results Of the 140 patients,13 patients(9.3%)had postoperative delayed cerebral infarction.The results of univariate analysis showed that the patients'Hunt-Hess grade score,modified Fisher grade,intraoperative anterior communicating aneu-rysm rupture,irregular aneurysm morphology,intraoperative application of indocyanine green fluorescence angiography,intraoperative ap-plication of papaverine,and intraoperative ventricular puncture drainage were statistically significant(P<0.05).Multivariate Logistic re-gression analysis of the factors with significant differences in univariate analysis showed that modified Fisher grade and intraoperative ante-rior communicating artery aneurysm rupture were independent risk factors for postoperative delayed cerebral infarction,while intraoperative application of indocyanine green fluorescence angiography was a protective factor(P<0.05).Conclusion Modified Fisher grade and in-traoperative anterior communicating artery aneurysm rupture were identified as independent risk factors for delayed cerebral infarction after microsurgical craniotomy clipping of anterior communicating artery aneurysm,while the intraoperative application of indocyanine green flu-orescence angiography can effectively reduce the incidence of postoperative delayed cerebral infarction after operation.
作者
封暴
余意
夏浩
吴俊逸
于佩名
任寅
朱玉辐
FENG Bao;YU Yi;XIA Hao(Xuzhou Medical University,Jiangsu 221004,China)
出处
《医学研究杂志》
2024年第7期136-140,共5页
Journal of Medical Research
基金
江苏省徐州市医学领军人才培养项目(XWRCHT20210031)。
关键词
前交通动脉瘤
开颅夹闭手术
术后迟发性脑梗死
影响因素
Anterior communicating artery aneurysm
Craniotomy clipping surgery
Postoperative delayed cerebral infarction
Influ-encing factors
