颅内未破裂动脉瘤介入术后脑缺血性损伤的危险因素分析

Risk factors of cerebral ischemic injury after endovascular coiling for unruptured intracranial aneurysms

目的:探讨颅内未破裂动脉瘤(unruptured intracranial aneurysms,UIA)经血管介入栓塞术后脑缺血性损伤的危险因素。方法:将收治的UIA患者274例根据介入栓塞术后有无新发脑梗死或有无神经功能障碍分为无脑缺血性损伤组165例和有脑缺血性损伤组109例,回顾性分析这274例患者的临床资料。采用单因素结合logistic回归分析的方法分析UIA介入栓塞术后脑缺血性损伤的危险因素。结果:UIA介入术后脑缺血性损伤患者有109例,占40%,其中34%的患者有明确的脑梗死灶(92例),6%的患者为单纯神经功能障碍(17例)。logistic回归分析显示无脑缺血性损伤组和有脑缺血性损伤组患者年龄(OR=2.547,95%CI=1.388~4.676,P=0.003)、高血压病史(OR=2.525,95%CI=1.307~4.881,P=0.006)、糖尿病史(OR=1.972,95%CI=1.050~3.701,P=0.035)、脑卒中病史(OR=9.325,95%CI=3.564~24.396,P<0.001)、脑动脉斑块粥样硬化(OR=3.680,95%CI=1.523~8.891,P=0.004)、术中血栓(OR=17.031,95%CI=4.042~71.756,P<0.001)及手术时间长短(OR=4.097,95%CI=2.126~7.894,P<0.001)差异有统计学意义,是UIA介入栓塞术后形成脑缺血性损伤的危险因素。结论:年龄、高血压病史、糖尿病史、脑卒中病史、脑动脉斑块粥样硬化、术中血栓及手术时间长短是UIA介入术后微小脑梗死灶形成的危险因素。

Objective：To investigate the risk factors of cerebral ischemic injury after endovascular coiling for unruptured intracranial aneurysms（UIA）. Methods：A total of 274 patients suffered from UIA for coil embolization including cerebral ischemic injury were enrolled and divided into negative group（n=165）and cerebral ischemic injury positive group（n=109）according to the MRI or clinical manifestation. Their clinical data were selected and analyzed respectively. Single-factor analysis and logistic regression model were used to analyze the risk factors of cerebral ischemic injury after endovascular coiling for UIA. Results：The total rate of cerebral ischemic injury after endovascular coiling was 40%,34% of the patients with micro-embolism and 6% with neurological dysfunction diseases.Age（OR=2.547,95%CI=1.388 to 4.676,P=0.003）,hypertension（OR=2.525,95%CI=1.307 to 4.881,P=0.006）,hyperglycemia（OR =1.972,95%CI=1.050 to 3.701,P=0.035）,previous stroke history（OR=9.325,95%CI=3.564 to 24.396,P0.001）,cerebral artery atherosclerosis patches（OR=3.680,95%CI=1.523 to 8.891,P=0.004）,intraoperative blood clots（OR=17.031,95%CI=4.042 to 71.756,P0.001）and procedure duration（OR=4.097,95%CI=2.126 to 7.894,P=0.007）associated significantly with cerebral ischemic injury and they were the risk factors of cerebral ischemic injury after endovascular coiling for UIA proved by logistic regression model.Conclusion：Age,hypertension,hyperglycemia,previous stroke history,cerebral artery atherosclerosis patches,intraoperative blood clots and procedure duration are the risk factors of cerebral ischemic injury after endovascular coiling for UIA.