脑动静脉畸形栓塞术后颅内出血的危险因素分析及防治措施

Risk factors of intracranial hemorrhage after endovascular therapy of cerebral arteriovenous malformations and its controlling measures

目的探讨脑动静脉畸形栓塞术后颅内出血的危险因素、出血后的处理措施及疗效。方法回顾性分析南方医科大学珠江医院自2002年1月至2012年6月收治的263例行血管内栓塞治疗脑动静脉畸形患者的临床资料，采用非条件性Logistic回归分析其栓塞术后颅内出血的危险因素。并总结栓塞术后出血的治疗策略，对术后所有出血的患者进行定期临床及影像学随访，评估该治疗策略的临床疗效。结果本组共有17例患者发生栓塞术后颅内出血。单次栓塞面积≥36．5％（OR=19．269：95％CI=1．283-289．299，P=0．032）、既往高血压病史（OR=7．962，95％CI=1．121-56．567．P=-0．038）是栓塞术后颅内出血的危险因素。结论单次面积栓塞≥36．5％和既往高血压病史可增加脑动静脉畸形栓塞术后颅内出血的风险，术后严格降压至基础血压的2／3且至少72h是减少栓塞术后继发颅内出血的关键。

Objective To identify the risk factors of hemorrhage after endovascular therapy of cerebral arteriovenous malformations （cAVMs）, and illustrate the prevention and management on this event as well as its postembolization outcomes evaluation for the purpose of guiding the clinical prevention and treatment decision in the future for hemorrhage after endovascular therapy of cAVMs. Methods We retrospectively reviewed the clinical records and images of 263 patients with cAVMs. The risk factors of hemorrhage after endovascular therapy of cAVMs were studied by using multivariate logistic regression for guiding the treatment strategy. All patients who suffered from hemorrhage after endovascular therapy of cAVMs received clinical and angiographic follow-up for outcome evaluating. Results Intracerebral hemorrhages occurred in 18 patients. A partial AVM reduction of ≥36.5% （OR=19.269, 95% CI： 1.283-289.299, P=-0.032） and hypertension （OR=7.962, 95% CI=1.121-56.567, P=0.038） were considered as risk factors for hemorrhage after endovascular therapy of cAVMs. Conclusions Patients who receives a partial AVM reduction of ≥36.5% in one session and who have hypertension history have a tendancy of increasing hemorrhage after endovascular therapy of cAVMs. Arterial blood pressure maintaines at 2/3 of baseline for at least 72 hours after embolization are confirmed to be the essential strategy, which would decrease the hemorrhage rate after endovascular therapy of cAVMs.