颅内破裂动脉瘤栓塞术后早期破裂再出血危险因素分析

Risk factors of early rebleeding after endovascular embolization of ruptured intracranial aneurysms

目的探讨颅内破裂动脉瘤栓塞术后早期破裂再出血的临床特点及危险因素,以减少动脉瘤栓塞术后早期再出血的发生率,为临床治疗方法的选择提供依据。方法回顾性分析我科2002年7月至2007年10月经全脑血管造影确诊的颅内破裂动脉瘤并行血管内介入栓塞治疗的病例,分析栓塞术后早期再出血病例(病例组)的临床及影像学特征,从同期治疗的未再出血的患者中随机抽取123例病例作为对照组,对两者的可疑危险因素进行单变量与多变量的统计学分析。结果881例行介入栓塞治疗的颅内破裂动脉瘤中有17例(1.93%)发生早期破裂再出血,其中12例(占70.6%)死亡。颅内破裂动脉瘤栓塞术后早期破裂再出血的独立危险因素为动脉瘤的真假性、术前动脉瘤的破裂次数、术中造影有明显的脑血管痉挛及动脉瘤的栓塞程度4项。并得到预测栓塞术后早期再出血概率的方程。结论本研究显示栓塞术后早期破裂再出血的发生率低,但预后差,病死率高。术前针对危险因素进行预防、术中尽可能致密栓塞动脉瘤、术后早期及时复查脑血管造影有利于减少颅内破裂动脉瘤栓塞术后早期再出血率,积极再治疗可以改善早期再出血患者的预后。

Objective To discuss the clinical characteristics and risk factors related to the early rebleeding after endovascular embolization of ruptured intracranial aneurysms, to reduce its occurrence and to provide the theoretical basis for the clinical selection of therapeutic methods.Methods During the period of July 2002-Oct.2007 in the Department of Neurosurgery of Changhai Hospital, patients with DSA-proved ruptured intracranial aneurysms were treated with percutaneous endovascular embolization.The clinical data and imaging findings of the patients who had occurred early rebleeding after interventional therapy（study group） were retrospectively analyzed.The patients who had not occurred early rebleeding after interventional therapy during the same period were randomly selected and served as the control group.The number of patients in control group was 7.5 times of that in study group.The suspected risk factors were statistically analyzed by using univariate and multivariate methods, the results were compared between two groups.Results Of 881 patients with ruptured intracranial aneurysms treated by endovascular interventional embolization, 17（1.93%） occurred rebleeding in the early time, among them 12（1.36%） died.The reality or falsity of the aneurysms, the ruptured times of the aneurysms before treatment, the obvious intracranial vascular spasms seen on DSA during the procedure and the degree of embolization were the four main independent risk factors related to the early rebleeding.The probability equation of the early rebleeding of ruptured intracranial aneurysms after endovascular embolization was calculated.Conclusion Although the incidence of early rebleeding in patients after endovascular embolization of ruptured intracranial aneurysms is low, the outcome, if it occurs, is poor with high mortality.Preoperative prevention measures directed against the risk factors, embolizing the ruptured intracranial aneurysm as completely as possible and prompt postoperative cerebral angiography are all very important for reducing the incidence of the early rebleeding.And active and effective dealing with the rebleeding can definitely improve the prognosis.