未破裂颅内动脉瘤夹闭术后慢性硬膜下血肿相关危险因素研究

Retrospective analysis of risk factors of chronic subdural hematoma after surgical clipping for unruptured intracranial aneurysms

目的探讨未破裂颅内动脉瘤(UIAs)患者动脉瘤夹闭术后慢性硬膜下血肿(CSDH)的发生率及相关危险因素。方法采用回顾性队列研究设计,连续收集2007年1月至2016年12月笔者单位神经外科收治的615例行动脉瘤手术夹闭的UIAs患者作为研究对象,收集患者临床资料、影像学检查及术后随访结果,计算术后CSDH的发生率,采用多因素Logistic回归模型分析UIAs患者术后发生CSDH的相关危险因素。结果 615例UIAs患者行动脉瘤夹闭术后,有71例患者发生了CSDH,术后CSDH的发生率为11. 5%。发生CSDH组患者的平均年龄明显高于未发生CSDH患者(62. 2±9. 7)岁vs(58. 9±9. 2)岁,差异有统计学意义(t=2. 825,P=0. 005)。年龄≥60岁、最大动脉瘤直径≥25 mm、脑萎缩分级3~4级、CT值≥40、硬膜下积液分级为IB与UIAs患者动脉瘤夹闭手术后发生CSDH相关;多因素Logistic回归分析发现,脑萎缩分级3~4级(OR=1. 979,95%CI:1. 940~2. 031)、CT值≥40(OR=3. 401,95%CI:2. 922~3. 868)、硬膜下积液分级IB(OR=2. 866,95%CI:2. 644~3. 012)是UIAs患者动脉夹闭术后发生CSDH的独立危险因素。结论脑萎缩分级3~4级、CT值≥40、硬膜下积液分级IB是UIAs患者动脉夹闭术后发生CSDH的独立危险因素。

Objective The incidence and risk factors of chronic subdural hematoma（CSDH） after surgical clipping for unruptured intracranial aneurysms（UIAs） were investigated. Methods A retrospective cohort study was adopted to collect 615 cases of unruptured intracranial aneurysms patients closed by aneurysm surgery who were admitted to Department of Neurosurgery of The Central District People＇s Hospital of Leshan City from January 2007 to December 2016. The clinical data,imaging findings and post-operative follow-up results were collected. The incidence of post-operative CSDH was calculated. Multivariate Logistic regression model was used to analyze the risk factors of post-operative CSDH in patients with UIAs. Results Among 615 cases of UIAs patients with aneurysm clipping surgery,71 patients had CSDH with post-operative CSDH incidence of 11. 5%. The mean age of patients with CSDH was significantly higher than those of patients without CSDH [（62. 2 ±9. 7） years vs（58. 9 ± 9. 2） years） ],and the difference was statistically significant（t =0. 825,P = 0. 005）. Age≥60 years old,maximal aneurysm diameter≥25 mm,brain atrophy Grade 3 -4,CT value≥40,subdural effusion Grade IB were correlated with UIAs patients with aneurysm clipping surgery after CSDH; multivariate Logistic regression analysis showed that the brain atrophy Grade 3 to 4 [Odds Ratio（OR） =1. 399,95% Confidence Interval（CI） ： 1. 940 - 2. 031） ],CT≥40（OR = 3. 401,95% CI：2. 922 -3. 868）,subdural effusion grade IB（OR =2. 866,95% CI： 2. 644 -3. 012） were the independent risk factor of CSDH after arterial occlusion in patients with UIAs. Conclusion Brain atrophy Grade 3 to 4,CT value ≥ 40,and subdural effusion Grade IB are the independent risk factors of CSDH after arterial occlusion in patients with UIAs.