颅内动脉瘤患者血管内栓塞术后预后影响因素分析

Analysis of the prognostic factors of endovascular embolization in the treatment of intracranial aneurysms

目的分析颅内动脉瘤患者血管内栓塞术后预后的影响因素。方法回顾性分析2014年6月至2017年1月本院收治的114例行血管内栓塞术治疗的颅内动脉瘤患者的临床资料,其中单纯栓塞治疗65例,支架辅助治疗49例;将预后良好的94例患者纳入预后良好组,预后不良的20例患者纳入预后不良组。采用改良Rankin量表(modified Rankin scale,MRS)对患者末次随访结果进行评分,并对两组患者的性别、年龄、基础疾病、术前Hunt-Hess分级、动脉瘤破裂情况、动脉瘤大小、部位、瘤颈、入院至手术时间、栓塞方式、术后栓塞程度等可能影响预后的因素进行对比分析。结果不同栓塞方式治疗的患者术后Raymond分级比较无显著差异(Z=1.257,P>0.05)。术前Hunt-Hess分级Ⅲ~Ⅳ级、动脉瘤直径>10 mm、入院至手术时间≥4天、单纯栓塞治疗均为影响颅内动脉瘤患者血管内栓塞术后预后的独立危险因素(P<0.05)。结论影响颅内动脉瘤患者血管内栓塞术后预后的危险因素较多,治疗前应全面评估患者的身体状态,选择合理的手术方式和手术时间,以提高疗效,改善患者预后。

Objective To analyze the prognostic factors of endovascular embolization in the treatment of intracranial aneurysms. Method The clinical data of 114 patients with intracranial aneurysms treated by intravascular embolization from June 2014 to January 2017 were analyzed retrospectively, of which 65 cases were treated with simple embolization and 49 cases were treated with stent assisted therapy. 94 patients with good prognosis were included in the good prognosis group, and 20 patients with poor prognosis were included in the poor prognosis group. Modified Rankin scale（MRS） was used to score the last follow-up results. The related factors such as sex, age, basic disease, preoperative Hunt-Hess classification, aneurysm rupture, aneurysm size, location, neck, admission to operation time, embolic mode and postoperative embolism degree that might affect the prognosis were compared and analyzed. Result There was no significant difference in Raymond grading after different embolization methods（Z = 1.257, P〈0.05）. Preoperative Hunt-Hess grade Ⅲ~Ⅳ, aneurysm diameter 10 mm, admission to operation time ≥ 4 days, and simple embolization therapy were the independent risk factors affecting the prognosis of intracranial aneurysms after intravascular embolization（P〈0.05）. Conclusion There are many risk factors affecting the prognosis of intracranial aneurysm patients after intravascular embolization. Before treatment, the patient＇s state of body should be evaluated comprehensively, the rational operation mode and operation time should be selected to improve the curative effect and the prognosis of the patients.