影响后交通动脉瘤手术疗效的多因素分析（附308例报道）

Multiple-factor analysis of factors affecting prognosis of posterior communicating artery aneurysm

目的探讨影响后交通动脉瘤（PCoA）手术疗效的多种因素，为提高术后疗效提供参考依据。方法回顾性收集并分析青岛大学附属医院神经外科自1997年1月至2013年6月手术治疗的308例PCoA患者的临床资料，以疗效作为因变量，选取可能影响疗效的13项指标[年龄，性别，蛛网膜下腔出血（SAH）次数，Hunt．Hess分级，术前神志情况，动脉瘤侧别、大小、发出部位及其指向，手术时机，术中动脉瘤有无破裂出血，CT示SAH特点，术后并发症1作为自变量，进行多分类有序Logistic回归分析．筛选出对疗效有显著意义的因素。结果患者性别，动脉瘤侧别、大小、发出部位及其指向，手术时机及术中有无破裂出血并非影响术后疗效的危险因素；患者年龄（P=0．003）、SAH次数（P=0．005）、Hunt-Hess分级（p=0．000）、术前神志情况（P=0．003）、CT示SAH特点（p=0．001）及术后并发症（p=0．000）是影响术后疗效的独立危险因素；而Hunt-Hess分级和术后并发症是影响术后疗效的独立危险因素（OR=14．330，P=0．000，95％CI：2．005～102．396；OR=19．445，p=0．004，95％CI：2．513～150．442）。结论通过对术前Hunt．Hess分级及术后并发症情况的分析可大致判定PCoA患者的预后，从而可进一步有针对性地指导PCoA的治疗，以提高临床治疗水平。

Objective To investigate the factors affecting the prognosis of posterior communicating artery aneurysm （PCoA） to provide theoretical foundation for treatment of PCoA. Methods The clinical data of 308 patients with PCoA, admitted to our hospital from January 1997 to June 2013, were studied retrospectively. With the therapeutic effect as the dependent variable, Logistic regression analysis was performed to examine 13 factors those potentially affected the outcomes of the patients. Results The patient＇s gender, side and size of PCoA, position and pointing of PCoA, timing of surgery and rupture or not during operation did not affect the outcomes of the patients （patient＇s age, gender, times of subarachnoid hemorrhage （SAH）, Hunt-Hess grade, preoperative condition of consciousness, side and size of PCoA, position and pointing of PCoA, timing of surgery, rupture or not during operation, degrees of SAH and postoperative complications）. But univariate analysis showed that the patient＇s age （P=0.003）, times of SAH （P=0.005）, Hunt-Hess grade （P=0.000）, preoperative consciousness situation （P=0.003）, degree of SAH （P=0.001） and postoperative complications （P=0.000） were the independent risk factors affecting the postoperative outcomes; whereas the Hunt-Hess grade and postoperative complications are fundamental risk factors that affected the postoperative effects （OR= 14.330, P=0.000, 95%CI： 2.005-102.396; OR=19.445, P=-0.004, 95%CI： 2.513-150.442）. Conclusion Preoperative Hunt-Hess grade and postoperative complications are independent risk factors affecting the prognosis of patients; through analysis of these factors, the prognosis of patients can be broadly determined, thus the treatment of PCoA can be further guided and level of clinical treatment can be improved.