颅内破裂微小动脉瘤预后的影响因素分析

Analysis of factors related to prognoses in the patients with very small ruptured intracranial aneurysms treated by surgery

目的探讨颅内破裂微小动脉瘤预后的影响因素。方法回顾性分析2012年11月至2016年8月手术治疗的63例颅内破裂微小动脉瘤的临床资料,采用多因素Logistic回归分析检验预后影响因素。结果术后6个月,采用GOS评分评估预后,预后良好(GOS评分4~5分)41例,预后不良22例。多因素Logistic回归分析显示入院时Hunt-Hess分级>Ⅲ级(OR=11.453,95%CI:1.888~69.495,P=0.008)、合并脑内血肿(OR=6.665,95%CI:1.298~34.236,P=0.023)、合并脑梗死(OR=11.353,95%CI:1.909~67.520,P=0.008)是影响破裂颅内微小动脉瘤病人预后的独立影响因素。结论颅内破裂微小动脉瘤入院时Hunt-Hess分级>Ⅲ级、合并脑内血肿、合并脑梗死,预后较差。这些因素可评估此类病人近期预后,指导临床诊治。

Objective To study factors related to the prognoses in the patients with very small ruptured intracranial aneurysmsafter the surgery.MethodsThe clinical data of 63 patients with very small ruptured intracranial aneurysms, who received surgical orendovascular treatment in our hospital from November, 2012 to August, 2016, were analyzed retrospectively. The relationships ofprognoses with the factors including the patients' age and gender, operative approach and opportunity, Fisher Scale and Hunt-Hessclassification on admission to hospital, intracerebral hematoma, and cerebral infraction were analyzed by univariate and multivariablelogistic regression analyses.ResultsThe univariate analysis showed that prognoses of patients with very small ruptured intracranialaneurysms were affected by Fisher Scale and Hunt-Hess classification on admission to hospital, intracerebral hematoma and cerebralinfraction(P<0.01). The multivariate logistic regression analysis showed that Hunt-Hess classification(>grade Ⅲ) on admission tohospital(OR=11.453, 95% CI: 1.888~69.495, P=0.008), intracerebral hematoma(OR=6.665, 95% CI: 1.298~34.236, P=0.023) andcerebral infraction(OR=11.353, 95%CI: 1.909~67.520, P=0.008) were independent risk factors affecting the prognoses in the patientswith very small ruptured intracranial aneurysms.ConclusionThe patients' Hunt-Hess classification on admission to hospital andwhether patients were complicated by intracerebral hematomas and cerebral infractions are of high value to predicting the prognoses inthe patients with very small intracranial aneurysms.