老年人颅内动脉瘤外科治疗的临床研究

A clinical research on the surgery of intracranial aneurysms in elderly patients

目的研究老年颅内动脉瘤的临床治疗特点。方法回顾性分析67例60岁以上的颅内动脉瘤病人的临床资料。依据出院时GOS评分将预后分为良好(4-5分)和差(1-3分),分别探讨年龄、姓别、治疗手段(手术和介入)、术前Hunt-Hess分级、高血压史、冠心病史、动脉瘤部位、大小、数量等因素的影响。结果GOS评分预后良好50例,差17例。中位住院时间手术治疗(19d)明显长于介入治疗(11d),差异具有统计学意义(P<0.05)。单因素分析显示术前Hunt-Hess分级与预后相关(P<0.05)。多因素的Logistic回归分析结果显示只有术前Hunt-Hess分级及动脉瘤部位与预后相关(P<0.05),而与其他因素无关(P>0.05)。结论术前Hunt-Hess分级低(0-2级)的老年动脉瘤效果良好,而高级别(3-4级)死亡率和伤残率仍较高。动脉瘤部位是影响预后的重要因素。在本组病例中,手术和介入的治疗效果未见明显差异。

Objective To study the clinical characteristics of intracranial aneurysms in elderly patients. Methods Clinical data from 67 patients older than 60 years with intracranial aneurysms were analyzed retrospectively. The patient＇s outcome at discharge according to the Glasgow Outcome Scale was divided into two categories： favorable （4～5 grades） or unfavorable （1～3 grades）. Those factors that might influence the outcome were evaluated, including gender, age, therapeutic tool （open surgery or endovascular treatment）, preoperative Hunt-Hess grades, history of hypertension, history of cardiovascular disease, location, size and number of aneurysms. Results Glasgow Outcome Scale was favorable in 50 cases and unfavorable in 17 cases. The median time in hospital for the open surgery （19 days） was significantly longer than that ofendovascular treatment （11 days） （P〈0.05）. The preoperative Hunt-Hess grades and the outcome was consistent in the univariable analysis （P〈0.05）. The results of multiple Logistic regression analysis showed that the preoperative Hunt-Hess grades and location of aneurysms were correlative with the outcome （P〈0.05）. Conclusion The elderly patients with good Hunt-Hess grades （0～2） have favorable outcome. However, in those with high Hunt-Hess grades （3～4）, morbidity and mortality rates remain high. The location of aneurysms is important factor for the outcome. In our patients, there is no significant difference in outcome between open surgery and endovascular treatment.