影响脑动静脉畸形栓塞术后颅内出血的高危因素分析

Risk factors of intracranial hemorrhage after endovascular therapy of cerebral arteriovenous malformation embolization

目的：探讨影响脑动静脉畸形（cAVM）栓塞术后颅内出血的高危因素。方法回顾性分析经过畸形血管团栓塞治疗的230例脑动脉畸形患者的临床资料，记录术后3 d 内颅内出血的发生情况，采用非条件 Logistic 回归法统计分析术后颅内出血的高危因素。结果术后共有15例患者出现颅内出血，治疗后畸形血管团面积为（2．18＆#177;0．91）cm，与治疗前（6．67＆#177;1．56）cm 相比患者畸形血管团面积明显缩小（t ＝9．627， P ＜0．05）。Logistic 回归分析显示患者的年龄、性别、出血史、癫痫史、SM分级及 cAVM大小与术后颅内出血无关（均 P ＞0．05），单次栓塞面积≥36．5％（P ＝0．031）和患者有既往高血压史（P ＝0．025）是栓塞术后患者颅内出血的高危因素。结论患者单次栓塞面积过大（≥36．5％）或术前有高血压史可诱发脑动静脉畸形栓塞术后颅内出血，密切观察血管栓塞情况，术后3 d 内严格降低患者血压对预防患者术后继发颅内出血有一定帮助。

Objective To study the risk factors of intracranial hemorrhage after endovascular therapy of cere-bral arteriovenous malformations embolization.Methods the clinical records and images of 230 patients with cAVMs were retrospectively reviewed.Patients with intracranial hemorrhage after endovascular therapy in 3 days were recorded and the risk factors of hemorrthage by using multivariate logistic regression for guiding the treatment strategy were studied.Results There were 15 patients occurred intracerebral hemorrhages.After treatment the area of cAVMs was significantly smaller than that before treatment[（2.18 ＆#177;0.91）cm vs （6.67 ＆#177;1.56）cm],the difference lvas a statis-tically significant （t =9.627,P 〈0.05）.A partial AVM reduction of ≥36.5%（P =0.031）and hypertension（P =0.025）were considered as risk factors for hemorrhage after endovascular therapy of cAVWs.Conclusion Patients receives a partial AVMreduction of ≥36.5% or with hypertension history have a tendancy of increasing hemorrhage after endovascular therapy of cAVMs.It＇s helpful for preventing intracerebral hemorrhage if the arterial blood pressure maintains after endovascular therapy.