显微手术治疗颅内动脉瘤术后CVS发生的相关因素及对预后的影响

Prognosis of microsurgical treatment of intracranial aneurysms and related factors of postoperative CVS analysis

目的探讨显微手术治疗颅内动脉瘤的临床效果,并分析影响术后脑血管痉挛(CVS)发生的相关因素及对预后的影响。方法回顾性分析2009年5月-2013年5月于郑州人民医院收治的128例颅内动脉瘤患者的临床资料。评价总体治疗效果,并分别应用单因素及Logistic多因素分析影响患者术后CVS发生的相关因素及对预后的影响。结果 128例患者总体治疗效果良好,术后发生CVS 32例(25.00%),与非CVS组比较,CVS组术后治愈率显著下降,而死亡率显著上升,差异有统计学意义(P<0.05)。经单因素分析可知,影响患者显微手术术后CVS发生的相关因素包括年龄、Hunt-Hees分级、Fisher’s分级、动脉瘤位置、手术时机、感染、基础疾病、终板造瘘、腰穿次数、血糖及白细胞水平。经Logsitic多因素进一步分析可知,Hunt-Hees分级、Fisher’s分级、动脉瘤位置、终板造瘘、腰穿次数是影响显微手术治疗颅内动脉瘤术后CVS发生的独立危险因子,并影响预后。结论显微手术治疗颅内动脉瘤临床效果良好,但须防范Hunt-Hees分级、Fisher’s分级、动脉瘤位置、终板造瘘、腰穿次数等影响术后CVS发生的独立危险因素,改善颅内动脉瘤患者预后。

Objective To explore the clinical effect of microsurgical treatment of intracranial aneurysms and analyze the effect of related factors on the prognosis of cerebral vasospasm （CVS）. Methods The clinical data of 128 patients with intraeranial aneurysms from May 2009 to May 2013 in our hospital were retrospectively analyzed. We evaluated the clinical effect first, then analyzed the related factors of microsurgery and their effect of postoperative patients with CVS occurred respectively by using single factor and Logistic multifactors. Results Generally, the overall operation effects of the 128 cases were benign, 32 cases （25.00%） occurred CVS postoperatively. Compared with the non-CVS group, the cure rate of CVS group dropped significantly, and mortality rate was considerably increased, the difference was statistically significant （P 〈 0.05）. The single factor analysis showed that the related factors influencing the microsurgery in patients with CVS postoperatively includeing age, Hunt-Hees grading, Fisher＇s classification, anemysm location, surgical timing, infection, basic diseases, endplate colostomy, the number of lumhar puncture, blood sugar and white blood cell levels. By Logsitic multi-factor analysis, Hunt-Hees grading, Fisher＇s classification, aneurysm location, colostomy, lumbar puncture times were found to be the independent factors. Conclusions The general operation effects of microsurgely are benign, Hunt-Hees grading, Fisher＇s classification,aneurvsm location and colostonly, lumbar puncture times and the endplate colostomy are independent risk factors for postoperative intracranial aneurvsms occur CVS. Prevent the CVS will be good for the prognosis of palients with inlraclanial aneurysms.