外科手术夹闭治疗已破裂前循环动脉瘤患者预后影响因素分析

Analysis of the risk factors for the prognosis of patients with ruptured anterior circulation aneurysms after surgical clipping

目的探讨外科手术夹闭治疗已破裂前循环动脉瘤患者预后的影响因素。方法回顾性分析2013年1月至2015年12月在黄冈市中心医院行外科手术夹闭治疗的82例已破裂前循环动脉瘤患者的临床资料,应用改良Rankin量表(MRS)评估患者的预后情况,并分析影响患者预后的相关因素。结果 82例患者全部成功随访,其中预后良好58例(MRS评分≤2),预后不良24例(MRS评分≥3),预后良好率为70.73%(58/82)。单因素分析结果显示,年龄、Hunt-Hess分级、Glasgow昏迷量表(GCS)评分、Fisher CT分级、术后脑血管并发症及颅内感染与已破裂前循环动脉瘤患者的预后有关(P<0.05),而性别、动脉瘤直径、动脉瘤位置、手术时间、出血次数及手术入路与已破裂前循环动脉瘤患者的预后无关(P<0.05)。Logistic回归分析结果显示,年龄、术后脑血管并发症、Hunt-Hess分级、GCS评分、Fisher CT分级是影响已破裂前循环动脉瘤患者预后的独立危险因素(P<0.05)。结论外科手术夹闭治疗已破裂前循环动脉瘤患者的预后影响因素较多,临床医师应及时评估患者病情,并制定干预措施。

Objective To explore the risk factors for the prognosis of patients with ruptured anterior circulation aneu- rysms after surgical clipping. Methods The clinical data of 82 patients with ruptured anterior circulation aneurysms who un- derwent surgical clipping in Huanggang Central Hospital from January 2013 to December 2015 were retrospectively analyzed. The prognosis of the patients was evaluated with modified Rankin scale （MRS） , and the risk factors for the prognosis of patients were analyzed. Results All 82 cases were successfully followed up, including 58 cases with good prognosis （MRS score ≤2 ） , 24 cases with poor prognosis （MRS score -〉3）, the good prognosis rate was 70.73% （58/82）. Univariate analysis showed that age, Hunt-Hess classification, glasgow coma scale （GCS） score, Fisher CT classification, postoperative cerebrovascular compli- cations and intracranial infection were associated with the prognosis of patients with ruptured anterior circulation aneurysm （ P 〈 0. 05 ） , while gender, the diameter of aneurysm, aneurysm location, operation time, the number of bleeding and surgical approach were unrelated with the prognosis of patients with ruptured anterior circulation aneurysms （ P 〈 0.05 ）. Logistic regres- sion analysis showed that age, postoperative cerebrovascular complications, Hunt-Hess classification, GCS score and Fisher CT classification were the independent risk factors for the prognosis of patients with ruptured anterior circulation aneurysms （ P 〈 0. 05 ）. Conclusion There are many factors influencing the prognosis of patients with ruptured anterior circulation aneurysms treated by surgical clipping. The clinicians should assess the patient＇s condition in time and make the intervention measures.