前交通动脉瘤夹闭术后预后的影响因素研究

Influencing Factors of Prognosis of Postoperative Anterior Communicating Artery Aneurysms Patients Treated by Aneurysm Clipping

目的探讨前交通动脉瘤夹闭术后预后的影响因素。方法选取广东省深圳市光明新区人民医院2012年2月—2015年2月收治的前交通动脉瘤患者62例,均进行前交通动脉瘤夹闭术,采用格拉斯哥预后量表(GOS)评价患者预后。收集患者性别、年龄、既往史(高血压、糖尿病、冠心病、高胆固醇血症等)、动脉瘤情况(位置、直径、走向、术前破裂情况及破裂次数等)、发病至手术时间、蛛网膜下腔出血严重程度、术前Hunt-Hess分级、术后并发症情况(脑梗死、脑积水、脑水肿、动眼神经麻痹等)等,采用多因素logistic回归分析筛选前交通动脉瘤夹闭术后预后的影响因素。结果 62例患者中预后良好45例(预后良好组),预后不良17例(预后不良组)。两组患者性别、年龄、高血压发生率、糖尿病发生率、冠心病发生率、高胆固醇血症发生率、动脉瘤位置、动脉瘤直径、动脉瘤走向、发病至手术时间、术后动眼神经麻痹发生率比较,差异均无统计学意义(P>0.05);两组患者术前动脉瘤破裂发生率、动脉瘤破裂次数、蛛网膜下腔出血严重程度、术前Hunt-Hess分级、术后脑梗死发生率、术后脑积水发生率、术后脑水肿发生率比较,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,蛛网膜下腔出血严重程度≥Ⅲ级〔OR=2.008,95%CI(1.926,3.054)〕、术前Hunt-Hess分级≥Ⅲ级〔OR=2.648,95%CI(1.552,4.463)〕、术前动脉瘤破裂〔OR=1.784,95%CI(1.142,2.864)〕、动脉瘤破裂次数〔OR=3.665,95%CI(1.158,5.167)〕、术后脑梗死〔OR=2.368,95%CI(1.228,4.032)〕、术后脑积水〔OR=1.883,95%CI(1.012,2.654)〕及术后脑水肿〔OR=1.630,95%CI(1.039,2.357)〕是前交通动脉瘤夹闭术后预后不良的危险因素(P<0.05)。结论蛛网膜下腔出血严重程度≥Ⅲ级、术前Hunt-Hess分级≥Ⅲ级、术前动脉瘤破裂、动脉瘤破裂次数、术后脑梗死、术后脑水肿及术后脑积水是前交通动脉瘤夹闭术后预后不良的危险因素。

Objective To analyze the influencing factors of prognosis of postoperative anterior communicating artery aneurysms patients treated by aneurysm clipping. Methods From February 2012 to February 2015,a total of 62 postoperative anterior communicating artery aneurysms patients treated by aneurysm clipping were selected in the People＇ s Hospital of New Guangming District,Shenzhen. Glasgow Outcome Scale was used to evaluate the prognosis; gender,age,past medical history（ including hypertension,diabetes,coronary heart disease and hypercholesterolemia）,aneurysms related conditions（ locations,sizes,move towards,incidence of preoperative rupture and rupture times）, duration between attack and surgery, severity of subarachnoid hemorrhage, preoperative Hunt-Hess grading and incidence of postoperative complications（ including cerebral infarction, hydrocephalus, encephaledema and oculomotor paralysis） were collected to analyze the influencing factors of prognosis of postoperative anterior communicating artery aneurysms patients treated by aneurysm clipping, multivariate logistic regression analysis was used. Results Of the 62 patients,45 cases got good prognosis（ served as A group）,17 cases got poor prognosis（ served as B group）. No statistically significant differences of gender, age, incidence of hypertension, diabetes,coronary heart disease or hypercholesterolemia,locations,diameter or move towards of aneurysms,duration between attack and surgery or incidence of postoperative oculomotor paralysis was found between the two groups（ P〉0. 05）; while there were statistically significant differences of severity of incidence of preoperative rupture of aneurysms, rupture times, subarachnoid hemorrhage,preoperative Hunt-Hess grading,incidence of postoperative cerebral infarction,hydrocephalus and encephaledema between the two groups（ P〈0. 05）. Multivariate logistic regression analysis showed that, equal or over Ⅲ-grade severity of subarachnoid hemorrhage 〔OR = 2. 008,95% CI（ 1. 926,3. 054） 〕,equal or over Ⅲ- grade preoperative Hunt-Hess grading〔OR = 2. 648,95% CI（ 1. 552,4. 463） 〕,preoperative rupture of aneurysms 〔OR = 1. 784,95% CI（ 1. 142,2. 864） 〕,rupture times 〔OR = 3. 665,95% CI（ 1. 158,5. 167） 〕,postoperative cerebral infarction 〔OR = 2. 368,95% CI（ 1. 228,4. 032） 〕,postoperative hydrocephalus 〔OR = 1. 883,95% CI（ 1. 012,2. 654） 〕and postoperative encephaledema 〔OR =1. 630,95% CI（ 1. 039,2. 357） 〕 were risk factors of poor prognosis of postoperative anterior communicating artery aneurysms patients treated by aneurysm clipping（ P〈0. 05）. Conclusion Equal or over Ⅲ- grade severity of subarachnoid hemorrhage,equal or over Ⅲ- grade preoperative Hunt-Hess grading, preoperative rupture of aneurysms, rupture times, postoperative cerebral infarction, postoperative hydrocephalus and postoperative encephaledema are risk factors of poor prognosis of postoperative anterior communicating artery aneurysms patients treated by aneurysm clipping.