颅内动脉瘤夹闭术后发生脑血管痉挛的危险因素分析

Risk factors of cerebral vasospasm after intracranial aneurysm clipping

目的分析颅内动脉瘤夹闭术后患者发生脑血管痉挛的危险因素,探讨其相应的预防措施。方法选取淮南市东方医院总院2015年5月-2018年5月收治的行颅内动脉瘤夹闭术的患者126例,根据患者术后临床表现、影像学检查结果,判断其术后脑血管痉挛发生情况,同时对影响患者术后发生脑血管痉挛的危险因素进行分析。结果患者的动脉瘤性蛛网膜下腔出血(subarachnoid hemorrhage,SAH)距手术时长(OR:0.596;95%CI:0.389～0.913)、Fisher分级(OR:1.421;95%CI:1.111～1.818)、术前SAH次数(OR:1.618;95%CI:1.071～2.445)、术前白细胞计数(OR:0.697;95%CI:0.493～0.986)、钙离子拮抗剂干预(OR:0.794;95%CI:0.678～0.930)、Hunt-Hess分级(OR:1.411;95%CI:1.148～1.734)等均是导致患者术后发生血管痉挛的显著影响因素。结论给予患者颅内动脉瘤夹闭术前应对患者术后合并症危险因素进行评估,开展有针对性的干预措施。

Objective To analyze the risk factors of cerebral vasospasm after treatment of intracerebral aneurysm clipping and discuss the corresponding preventive measures. Methods A total of 126 patients who were treated by intracranial aneurysms clipping surgery from May 2016 to May 2018 in our hospital were included in our study. The occurrence of postoperative cerebral vasospasm was determined according to the postoperative clinical manifestations and imaging examination results, and the risk factors of cerebral vasospasm after operation was analyzed. Results The time from onset of aneurysmal subarachnoid hemorrhage(SAH) to operation(OR, 0.596;95% CI, 0.389-0.913), Fisher’s classi?cation(OR, 1.421;95% CI, 1.111-1.818), history of SAH(OR, 1.618;95% CI, 1.071-2.445), preoperative Leukocyte(OR, 0.697;95% CI, 0.493-0.986), calcium antagonist intervention(OR, 0.794;95%CI, 0.678-0.930) and Hunt-Hess classi?cation(OR, 1.411;95% CI, 1.148-1.734) were the risk factors of postoperative vasospasm.Conclusion For patients undergoing intracranial aneurysm, assessment of postoperative risk factors should be done before treatment so as to carry out targeted interventions.