后交通动脉瘤引起动眼神经麻痹的临床因素分析

Clinical analysis of oculomotor paralysis caused by posterior communicating artery aneurysm

目的探讨后交通动脉瘤(PcoAA)是否发生动眼神经麻痹(OMNP)的临床因素。方法收集113例单侧PcoAA病例,分为OMNP组和非动眼神经麻痹(No-oculomotor nerve palsy,NOMNP)组。每个研究对象均记录以下因素:性别、年龄、瘤体位置、瘤体最大径、瘤顶指向、蛛网膜下腔出血和动眼神经麻痹。对比分析这些因素在OMNP组和NOMNP组之间的差异。结果OMNP组共40例,瘤体最大径平均9.863mm,瘤顶指向后34例、下33例;NOMNP组共73例,瘤体最大径平均5.588mm,瘤顶指向后47例、下43例。OMNP组瘤体最大径明显大于NOMNP组,差异有统计学意义(t=7.858,P<0.01);OMNP组瘤顶指向后(x2=5.411,P<0.05)、下(x2=6.533,P<0.05)者均多于NOMNP组,差异有统计学意义。两组之间性别、年龄、瘤体位置和蛛网膜下腔出血发生率的比较,差异均无统计学意义(P>0.05)。结论动脉瘤的大小、瘤顶指向是PcoAA患者发生OMNP的独立危险因素。

OBJECTIVE To explore clinical factors which have influenced whether patients with posterior communicating artery aneurysm （PcoAA） who presented oculomotor paralysis. METHODS A total of 133 patients with lateral PcoAA were collected for the study. These patients were divided into the oculomotor paralysis group （OMNP） and the non-oculomotor paralysis group （NOMNP）. These following factors were recorded for each study subject：gender,age,site and maximal diameter of aneurysm,pointedness of aneurysm,subarachnoid hemorrhage and oculomotor paralysis. Comparison of each factor was conducted between OMNP and NOMNP. RESULTS Forty cas-es,which maximal diameter of aneurysm was 9.863 mm,had the clinical symptoms of oculomotor paralysis with 34 cases of backward-pointed aneurysm and 33 cases of downward-pointed aneurysm. 73 cases,which maximal diameter of aneurysm was 5.588 mm,had not the clinical symptoms of oculomotor paralysis with 47 cases of backward-pointed aneurysm and 43 cases of downward-pointed aneurysm. The maximal diameter of aneurysm in OMNP group was exceeded in NOMNP group （t=7.858,P0.001）,with statistical significance. The backward-pointed（x2=5.411,P0.05） and downward-pointed （x2=6.533,P0.05） aneurysm in OMNP group were more than in NOMNP group,with statistical significance. Statistically insignificant differences were found when comparing gender,age,site of aneurysm and incidence of subarachnoid hemorrhage between two groups. CONCLISION The size and pointedness of aneurysm were the independent risk factors that influences whether patients with lateral PcoAA who presented oculomotor paralysis.