未破裂与破裂颅内动脉瘤夹闭术后慢性硬膜下血肿发生率及相关危险因素的对比分析

Comparative analysis of the incidence and predictors of chronic subdural hematoma after surgical clipping between unruptured intracranial aneurysms and ruptured intracranial aneurysms

目的探讨未破裂颅内动脉瘤(UIAs)与破裂动脉瘤(RIAs)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,选取2009年10月至2017年12月本院神经外科收治的486例行动脉瘤夹闭术患者(UIAs患者102例、RIAs患者384例)作为研究对象,收集患者临床资料、手术前后影像学检查资料和术后随访结果,比较UIAs患者和RIAs患者术后CSDH的发生率,采用多因素Logistic回归模型分析UIAs患者和RIAs患者术后发生CSDH的相关危险因素。结果 UIAs和RIAs患者在CSDH的发生率(10.78%vs 3.13%;x^2=10.487,P=0.001)以及CSDH后再手术治疗率(3.92%vs 0.78%;x^2=5.599,P=0.018)差异均有统计学意义,均表现为UIAs患者高于RIAs患者。脑萎缩3～4级(OR=1.978,95%CI:1.939～2.030,P<0.001)、硬膜下积液CT值≥40(OR=3.394,95%CI:2.908～3.867,P<0.001)以及硬膜下积液分级为ⅠB(OR=2.872,95%CI:2.648～3.019,P <0.001)是UIAs患者动脉瘤夹闭术后发生CSDH的独立危险因素(P <0.05)。膜下积液CT值≥40(OR=3.442,95%CI:2.918～3.8769,P <0.001)和硬膜下积液分级为ⅠB级(OR=2.329,95%CI:2.011～2.564,P<0.001)是RIAs患者动脉瘤夹闭术后发生CSDH的独立危险因素(P <0.05)。结论 UIAs患者动脉瘤夹闭术后CSDH的发生率明显高于RIAs患者,两组患者术后发生CSDH的危险因素也不尽相同。

Objective To analyze the incidence and predictors of chronic subdural hematoma （ CS- DH） after surgical clipping between unruptured intraeranial aneurysms （UIAs） and ruptured intracranial aneurysms （RIAs）. Methods A retrospective cohort study was adopted to collect 486 cases of aneurysm patients （ 102 cases of UIAs patients and 384 RIAs patients） closed by aneurysm surgery who were admitted to the department of neurosurgery of The Fifth People＇s Hospital of Chengdu from October 2009 to December 2017. The clinical data, preoperative and postoperative imaging data and postoperative follow-up results were collected. The incidence of CSDH after operation in UIAs patients and RIAs patients was compared. The risk factors of CSDH after UIAs and RIAs patients were analyzed by multivariate Logistic regression model. Results The incidence of CSDH in UIAs and RIAs patients （10. 78% vs 3.13%, X2 = 10. 487, P =0. 001 ） and the reoperation rate after CSDH （3.92% vs 0.78% ; X2 =5. 599, P =0. 018） were all sta- tistically different, all of which showed that the patients with UIAs were higher than those of the patients with RIAs. Brain atrophy of grade 3 - 4 （ OR = 1. 978, 95% CI： 1. 939 - 2. 030, P 〈 0. 001 ） , subdural ef- fusion CT value ≥40 （ OR = 3. 394, 95% CI：2. 908 - 3. 867, P 〈 0. 001 ） and subdural effusion （ OR = 2. 872, 95% CI：2. 648 - 3. 019, P 〈 0. 001 grade） of I B are independent risk factors of CSDH in patients with UIAs after aneurysm clipping （P 〈 0. 05 ）. Subdural effusion CT value ≥ 40 （ OR = 3.442, 95% CI：2.918-3.8769, P〈0.001） and grade I B subdural effusion （OR =2.329, 95% CI：2.011 -2.564, P 〈 0. 001 ） are independent risk factors for CSDH in patients with RIAs after aneurysm clipping （ P 〈 0. 05）. Conclusions The incidence of CSDH after aneurysm clipping in UIAs patients was significantly higher than that of RIAs patients. The risk faetors for CSDH in the two groups were not the same.