后交通动脉瘤性动眼神经麻痹在栓塞术后的恢复情况及相关影响因素分析

Recovery of posterior communicating artery aneurysm-induced oculomotor nerve paresis after endovascular treatment and its related factors analysis

目的 探讨后交通动脉瘤性动眼神经麻痹在动脉瘤栓塞术后的恢复情况以及影响恢复的相关因素。方法 回顾性收集湖北医药学院附属襄阳医院神经科自2007年7月至2013年1月行动脉瘤栓塞术的随访资料完整的55例后交通动脉瘤性动眼神经麻痹患者的临床资料,分析患者术后动眼神经麻痹的恢复情况,以及采用单因素分析和多因素Logistic逐步回归法探讨可能影响动眼神经麻痹恢复的因素。结果 随访1年以上,31例（56.4％）完全恢复,19例（34.5％）部分恢复,5例（9.1％）无变化.多因素Logistic回归分析显示,影响栓塞术后动眼神经麻痹完全恢复的相关因素是术前麻痹程度（OR=5.366,95％CI：1.253～22.974,P=0.024）、术前麻痹时间（OR=5.518,95％CI：1.398～21.774,P=0.015）、甲钴胺治疗与否（OR=6.988,95％CI：1.659～29.431,P=0.008）。 结论 后交通动脉瘤栓塞术可促进后交通动脉瘤性动眼神经麻痹的好转,术前不全麻痹、术前麻痹时间短、使用甲钴胺治疗是影响后交通动脉瘤性动眼神经麻痹完全恢复的相关因素。

Objective To investigate the evolution of posterior communicating artery （PcomA） aneurysm-induced oculomotor nerve paresis （ONP） and the factors affecting the outcome of ONP after endovascular packing of PcomA.Methods A total of 55 patients with ONP attributable to PcomA,admitted to our hospital from July 2007 to January 2013,were chosen in our study; their clinical data were retrospectively analyzed.The recoveries of ONP were analyzed;univariate analysis and multivariate Logistic regression were used to explore the possible influencing factors of recovery.Results At least one year follow up showed that there was a complete resolution of ONP in 31 patients （56.4%）,partial improvement in 19 （34.5%） and no changes in 5 （9.1%）.Multivariate Logistic regression analysis indicated that preoperative degrees of paralysis （OR=5.366,95%CI：1.253-22.974,P=0.024）,preoperative paralysis time （OR=5.518,95%CI：1.398-21.774,P=0.015） and mecobalamine treatment （OR=6.988,95%CI：1.659-29.431,P=0.008） were significantly associated with the recoveries ofoculomotor nerve function after endovascular treatment.Conclusion Endovascular treatment can promote the recovery of PcomAaneurysm-induced ONP,and preoperative degrees of paralysis,preoperative paralysis time and mecobalamine treatment are factors influencing the complete recovery of ONP.