影响单发后交通动脉瘤夹闭术疗效的围手术期多因素分析

Perioperative multifactor analysis on effect of single posterior communicating artery aneurysm clipping

目的探讨影响后交通动脉瘤(PCo A)夹闭术疗效的相关因素,为提高手术效果改善患者预后提供借鉴。方法回顾性分析2012年1月至2017年6月204例行开颅夹闭术且符合纳入标准的后交通动脉瘤患者的临床资料,以格拉斯哥预后量表(GOS)评分作为预后标准,选取可能影响预后的12项因素先进行单因素分析,选取其中有统计学意义因素进行多分类有序Logistic回归分析并选择出对预后有意义的因素。结果患者的性别、年龄、动脉瘤大小、术后并发症、术中血流阻断时间、动眼神经麻痹不是影响手术预后的因素,而Fisher分级、术中有无破裂、术前Hunt-Hess分级、术前SAH次数、脑血管痉挛(CVS)、动脉瘤颈宽是影响预后的因素。其中,术前Hunt-Hess分级(P=0.000)、术前SAH次数(P=0.001)、脑血管痉挛(P=0.000)是影响手术疗效的独立危险因素。结论通过对术前Fisher分级、术中有无破裂、术前Hunt-Hess分级、术前SAH次数、脑血管痉挛、动脉瘤颈宽的分析,可对患者的预后情况进行评估。

Objective To explore the related factors of the effect of post-operative arterial aneurysm（ PCo A） and to improve the prognosis of patients. Methods The clinical data of 204 patients who underwent aneurysm clipping were performed by Glasgow outcome scale（ GOS） were analyzed retrospectively. Results The patients＇ gender,age,and the size of the aneurysm,postoperative complications,oculomotor nerve paralysis,intraoperative blood flow blocking time was not the significant factors influencing the prognosis of surgery,and Fisher grading,intraoperative rupture,preoperative Hunt-Hess grading,times of preoperative SAH,cerebral vasospasm（ CVS）,aneurysm neck width was the independent risk factors affecting prognosis,among them,the preoperative Hunt-Hess classification（ P = 0. 000）,number of preoperative SAH（ P = 0. 001）,cerebral vasospasm（ CVS）（ P = 0. 000） was a strong correlation factors influencing surgical curative effect. Conclusion The preoperative Fisher grading,intraoperative rupture,preoperative Hunt-Hess classification,times of preoperative SAH,cerebral vasospasm（ CVS）,aneurysm neck width analysis can assess the patient＇s prognosis.