支架辅助弹簧圈栓塞治疗颅内动脉瘤围手术期并发症的危险因素分析

Risk factors of perioperative complications of cerebral aneurysms after stent-assisted coiling

目的探讨支架辅助弹簧圈栓塞治疗颅内动脉瘤围手术期并发症的危险因素。方法回顾性收集南方医科大学珠江医院神经外科自2011年1月1日至2017年12月31日收治的395例行支架辅助弹簧圈栓塞治疗的颅内动脉瘤患者的临床资料,采用单因素及多因素Logistic回归分析筛选患者围手术期并发症(术中支架内血栓形成和出血事件、术后缺血性和出血性事件及其他无法分类的并发症)的危险因素,并进一步对术前动脉瘤状态进行Hunt-Hess分级及行趋势性检验。结果术中支架内血栓形成和出血事件的发生率分别为2.28%(9/395)和1.01%(4/395),术后缺血性和出血性事件的发生率分别为3.54%(14/395)和1.27%(5/395),另有1例患者同时发生术中支架内血栓形成和术后缺血性事件。单因素Logistic回归分析显示术前动脉瘤破裂是围手术期并发症的危险因素(OR=2.466,95%CI:1.267~4.797,P=0.008)。多因素Logistic回归分析显示糖尿病(OR=4.275,95%CI:1.260~14.508,P=0.020)和术前动脉瘤破裂(OR=2.442,95%CI:1.182~5.043,P=0.016)是围手术期并发症的独立危险因素。趋势性检验显示,与低Hunt-Hess分级相比,较高的Hunt-Hess分级患者发生围手术期并发症的风险较高(OR=1.514,95%CI:1.144~2.004,P=0.004)。结论糖尿病或术前动脉瘤破裂患者发生围手术期并发症的概率较高。Hunt-Hess分级能够比较准确地判断围手术期并发症的发生风险。

Objective To explore the risk factors of perioperative complications of cerebral aneurysms after stent-assisted coiling. Methods A retrospective analysis of clinical data of 395 patients with cerebral aneurysms after stent-assisted coiling,admitted to our hospital from January 1,2011 to December 31,2017,was performed.Univariate and multivariate Logistic regression analyses were used to determine the risk factors of perioperative complications of cerebral aneurysms after stent-assisted coiling(intraoperative stent thrombosis and bleeding events,postoperative ischemic and hemorrhage events,and other unclassified complications).The preoperative aneurysm status was analyzed by Hunt-Hess grading and Trend test was conducted to analyze its statistical significance. Results Intraprocedural thrombosis and hemorrhage occurred in 2.28%patients(9/395)and 1.01%patients(4/395),respectively.Postprocedural ischemic stroke and hemorrhage occurred in 3.54%patients(14/395)and 1.27%patients(5/395),respectively.One patient suffered intraprocedural thrombosis and postprocedural ischemic stroke.Univariate Logistic regression analysis showed that pretreatment ruptured aneurysm was the risk factor of perioperative complications(OR=2.466,95%CI:1.267-4.797,P=0.008).In multivariate Logistic regression analysis,diabetes and pretreatment ruptured aneurysm were independent risk factors of perioperative complications(OR=4.275,95%CI:1.260-14.508,P=0.020;OR=2.442,95%CI:1.182-5.043,P=0.016).As compared with patients with low Hunt-Hess grading,patients with high Hunt-Hess grading had higher risk of perioperative complications in tests for linear trend(OR=1.509,95%CI:1.142-1.993,P=0.004). Conclusions The incidence of perioperative complications is high in patients with diabetes or pretreatment ruptured aneurysm.Hunt-Hess grading can accurately determine the risk of perioperative complications.