开颅夹闭术中前循环动脉瘤破裂患者的预后影响因素分析

Analysis of the prognostic factors in patients with anterior circulation aneurysms ruptured during the craniotomy

目的探讨开颅夹闭术中前循环动脉瘤（ACA）破裂患者的预后影响因素。方法回顾性分析2012年3月至2015年7月在黄冈市中心医院行开颅夹闭术中发生动脉瘤破裂（IAR）的40例ACA患者的临床资料,采用单因素和多因素logistic回归分析对IAR患者的预后影响因素进行分析。结果 40例IAR患者中,预后好者34例（预后好组）,预后差者6例（预后差组）。2组患者的性别、年龄、高血压病史、动脉瘤直径、术中是否使用临时阻断夹及阻断时间、术中失血量比较差异均无统计学意义（P〉0.05）,2组患者的术前Hunt-Hess分级、动脉瘤破裂点比较差异有统计学意义（P〈0.01）。术前Hunt-Hess分级Ⅳ-Ⅴ级、瘤颈部破裂是影响IAR患者预后的独立危险因素（P〈0.01）。结论术前Hunt-Hess分级越高、瘤颈部破裂是导致IAR患者预后不良的重要因素。

Objective To investigate the prognostic factors in patients with anterior circulation aneurysms（ ACA） ruptured during the craniotomy. Methods The clinical data of 40 ACA patients with intraoperative aneurysm ruptured（ IAR）during the craniotomy in Huanggang Central Hospital from March 2012 to July 2015 were retrospectively analyzed. The prognostic factors in patients with IAR were analyzed by univariate and multivariate logistic regression analysis. Results Among the 40 patients with IAR,the prognosis was good in 34 cases（ good prognosis group）,and the prognosis was poor in 6 cases（ poor prognosis group）. There was no significant difference in the sex,age,history of hypertension,aneurysm diameter,whether using the temporary arterial clamp and the blocking time,intraoperative blood loss between the two groups（ P〈0. 05）. There was significant difference in the preoperative Hunt-Hess classification and aneurysm ruptured point between the two groups（ P〈 0. 01）. Preoperative Hunt-Hess classification Ⅳ- Ⅴ and aneurysm neck rupture were the independent risk factors in the prognosis of patients with IAR（ P〈 0. 01）. Conclusion The higher preoperative Hunt-Hess classification and aneurysm neck rupture are the important poor prognostic factors in IAR patients.