前循环动脉瘤夹闭术中动脉瘤破裂的预见因素分析

Intraoperative rupture of anterior circulation aneurysm treated by clipping: analysis of predictable factors

目的探讨颅内前循环动脉瘤夹闭术前预见术中动脉瘤破裂有效预见因素。方法对2010年1月至2012年2月期间在我院神经外科接受开颅动脉瘤夹闭术的75例患者的临床资料进行回顾性分析,对可能的预见因素如动脉瘤位置、动脉瘤子阜、顶颈比、指向、术前Hunt-Hess评级、高血压病史及手术时机等进行单因素统计学分析和Logistic回归多因素分析。结果在75例患者的88个动脉瘤夹闭术中,有16例患者的16个动脉瘤发生术中破裂(占动脉瘤18.2%,占患者22.9%),所有患者术后Rank评分为0分51例,2分8例,3分5例,4分3例,5分5例,6分3例。统计学分析结果显示,既往是否有高血压病史(P=0.036,优势比(OR)=0.408),术前Hunt-Hess评级(P=0.041,OR=0.426),动脉瘤指向(P=0.008,OR=0.341),瘤体是否具有小阜(P=0.008,OR=0.517),手术时机(P=0.000,OR=0.316)以及动脉瘤顶颈比(P=0.028,OR=0.163)都是IAR发生的预见性因素,动脉瘤的位置(P=0.187)不是预见性因素。结论既往有高血压病史,术前Hunt-Hess评级为重症,动脉瘤指向术者,瘤体具有小子阜,早期手术以及顶颈比在1.97±0.67范围内的动脉瘤在术中较易发生破裂,术中破裂是各种因素综合作用的结果。

Objective To discuss the predictable factors for the occurrence of intraoperative aneurysm rupture （IAR）. Methods A total of 75 patients with 88 aneurysms treated by neurosurgical clipping from January 2010 to February 2012, were retrospectively analyzed. The statistic analysis was performed for the risk factors of IAR such as aneurysm location, aneurysm sac, dome/neck ratio, direction, pre-operative Hunt-Hess Scale, history of hypertension and operation time. Results Sixteen IARs occurred （ 18.2% of aneurysms, 22.9% of patients） during the operation. Outcome of patients was estimated by Rank Scale： 0 was for 51 patients, 2 was for 8 patients, 3 was for 5 patients, 4 was for 3 patients, 5 was for 5 patients and 6 was for 3 patients at 3 months after surgery. Statistic analysis revealed that history of hypertension （P = O. 036, odds ratio （ OR ） = O. 408 ） , pre-operative Hunt-Hess scale （ P = 0. 041 , OR = O. 426 ）, direction（P =0.008, OR =0.341 ） , aneurysm sac（P =0.008, OR =0. 517） , operation time（ P = 0. 000, OR = O. 316 ） and dome/neck ratio （ P = O. 028, OR = 0. 163 ） were the predictable factors for the occurrence of IAR, while the location of aneurysm was not included. Conclusion Hypertension history, Hunt-Hess scale, direction, aneurysm sac, operation time and dome/neck ratio （1.97 ± O. 67 ） are the predictable factors for the occurrence of IAR and the combination of various factors leads to the occurrence of IAR.