前交通动脉动脉瘤预后的影响因素分析

Analysis of factors related to prognoses in patients with anterior communicating artery aneurysms

目的探讨影响前交通动脉动脉瘤(ACoAA)预后的危险因素。方法回顾性分析2010年11月至2016年11月手术治疗的60例ACoAA的临床资料,采用多因素Logistic回归分析检验ACoAA预后的影响因素。出院时按GOS评分评估预后,4~5分表示预后良好,1~3分表示预后不佳。结果 60例中,预后良好43例,预后不佳17例。多因素Logistic回归分析显示,动脉瘤直径>2.5 cm、术前动脉瘤破裂、术前Hunt-Hess分级≥Ⅲ级、蛛网膜下腔出血≥Ⅲ级、术后脑梗死以及术后脑水肿是影响ACoAA预后的独立危险因素。结论 ACoAA预后影响因素很多,动脉瘤巨大、术前Hunt-Hess分级高、术后并发脑梗死和脑水肿,预后不佳。

Objective To analyze the risk factors related to the prognoses in patients with anterior communicating arteryaneurysms （ACoAA）. Methods The clinical data of 60 patients with ACoAA who underwent surgery from November, 2010 to November,2016 were analyzed retrospectively, and the factors related to the prognoses in the patients with ACoAA were analyzed. Results Of 60patients with ACoAA undergoing surgery, 43 （71.67%） had good prognoses and 17 （28.33%） poor. The univariate analysis showed thatthe factors related to the prognoses included the diameter of aneurysms, preoperative aneurysm rupture, times of aneurysm rupture,preoperative Hunt-Hess grade, severity of subarachnoid hemorrhage, timing of operation and postoperative cerebral infarction, brainedema and hydrocephalus in the patients with ACoAA （P〈0.05）. The multivariate analysis showed that the independent risk factorsrelated to the prognoses included the diameter of aneurysm 〉2.5 cm, preoperative aneurysm rupture and Hunt-Hess grade ≥grade Ⅲ,the severity of subarachnoid hemorrhage ≥grade Ⅲ and postoperative cerebral infarction and brain edema in the patients with ACoAAundergoing the surgery. Conclusion The diameter of aneurysms〉2.5 cm, preoperative aneurysm rupture, and Hunt-Hess grade ≥gradeⅢ, the severity of subarachnoid hemorrhage ≥grade Ⅲ and postoperative cerebral infarction and brain edema are independent riskfactors related to the poor prognoses in patients with ACoAA after the surgical treatment.