脑动脉瘤开颅术后死亡原因及相关风险因素的临床分析

Clinical Analysis of Cause of Death and Related Risk Factors after Craniotomy of Cerebral Aneurysm

目的:总结脑动脉瘤开颅术后患者死亡原因并进行相关风险因素的探讨。方法:回顾性总结和分析某科2010年1月~2015年9月138例脑动脉瘤开颅术后死亡患者的临床资料,采用多因素Logistic回归分析模型进行风险因素的评估。结果:颅内再出血者51例,术后脑血管痉挛或脑缺血者48例,术后心脏骤停4例(因突发心梗),术后肺部感染17例,术后肾功能衰竭者3例,颅内感染6例,脑梗死9例。手术时机和Hunt-Hess分级均与死因具有相关性(列联系数分别为0.374和0.217,P<0.05)。影响颅内再出血的相关风险因素主要为年龄和高血压(OR值分别为17.417和9.216,P<0.05),而影响术后脑血管痉挛的风险因素主要为年龄和Fisher分级(OR值分别为12.696和6.292,P<0.05),法舒地尔/尼莫地平的使用则是该脑血管痉挛或脑缺血的保护性因素。结论:颅内再出血和脑血管痉挛是脑动脉瘤开颅术后患者死亡的主要原因,对其相关的危险因素进行早期干预可能提高手术治疗效果,降低死亡率。

Objective：To summarize the causes of death in patients with cerebral aneurysm after craniotomy and to explore the related risk factors.Methods：The clinical data of 138 patients with cerebral aneurysm after craniotomy were retrospectively reviewed and analyzed.The risk factors were evaluated by multivariate logistic regression analysis.Results：There were 51 cases of intracranial hemorrhage,48 cases of postoperative cerebral vasospasm or cerebral ischemia,4cases of postoperative cardiac arrest,17 cases of postoperative pulmonary infection,postoperative renal function failure in 3cases,intracranial infection in 6cases,9cases of cerebral infarction.The timing of surgery and Hunt-Hess grade were correlated with the cause of death（column correlations were 0.374 and 0.217,P〈0.05）.The risk factors of cerebral vasospasm were age and hypertension（OR=12.696 and 6.292,P〈0.05）.The use of fasudil/nimodipine was a protective factor for cerebral vasospasm or cerebral ischemia.Conclusion：Intracranial rebleeding and cerebral vasospasm are the main causes of death after craniotomy of cerebral aneurysm.Early intervention of related risk factors may improve the effect of surgical treatment and reduce the mortality rate.