血管内介入栓塞术治疗前循环破裂颅内动脉瘤临床疗效及预后危险因素分析

Effect of intravascular interventional embolization in treatment of anterior circulation ruptured intracranial aneurysms and risk factors of prognosis

目的:探讨血管内介入栓塞术治疗前循环破裂颅内动脉瘤患者临床疗效及预后危险因素分析。方法:选取116例行血管内介入栓塞术治疗的前循环破裂颅内动脉瘤患者为研究对象,对患者临床资料进行回顾性分析。所有患者均行血管内介入栓塞术治疗,比较所有患者手术后的栓塞效果以及手术前后的改良Rankin量表(MRS)评分,术后随访6个月,依据患者格拉斯哥预后(GOS)评分将患者分为预后良好组和预后不良组,采用单因素分析和多因素Logistic回归分析前循环破裂颅内动脉瘤患者血管内介入栓塞术后预后不良的危险因素。结果:所有前循环破裂颅内动脉瘤患者术后动脉瘤血管平均栓塞范围(98.49±9.12)%,完全栓塞达90.52%,术后MRS评分较术前明显下降(P<0.05);预后不良组和预后良好组在高血压病史、入院时GCS评分、Hunt-Hess分级、CT-Fisher分级和发病至手术时间方面比较差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,有高血压病史、Hunt-Hess分级Ⅲ~Ⅳ级、CT-Fisher分级3~4级是前循环破裂颅内动脉瘤患者血管内介入栓塞术后预后不良的独立危险因素。结论:血管内介入栓塞术治疗前循环破裂颅内动脉瘤可获得较好的栓塞效果,改善患者神经功能,临床效果肯定。但有高血压病史、Hunt-Hess分级Ⅲ~Ⅳ级、CT-Fisher分级3~4级均是导致患者术后预后不良的独立危险因素,临床应予以重视并积极防范。

Objective:To explore the effect of intravascular interventional embolization(IIE)in treatment of anterior circulation ruptured intracranial aneurysms(ACRIA)and risk factors of prognosis. Methods:A total of 116 ACRIA patients who underwent IIE were enrolled as study objects. The clinical data of patients were analyzed retrospectively. The embolization effect after surgery and scores of modified Rankin Scale(MRS)before and after surgery were compared. The patients were followed up for 6 months after surgery,and divided into good prognosis group and poor prognosis group according to scores of Glasgow Outcome Scale(GOS). Univariate analysis and multivariate Logistic regression analysis were applied to analyze risk factors of poor prognosis in ACRIA patients after IIE. Results:Among all ACRIA patients after surgery,average embolization range of aneurysm vessels and complete embolization rate were(98.49±9.12)% and 90.52%,respectively. MRS score was significantly decreased after surgery(P<0.05). There were significant differences in hypertension history,Glasgow Coma Scale(GCS)score at admission,Hunt-Hess classification,CT-Fisher classification,and the time from onset to operation between good prognosis group and poor prognosis group(P<0.05). The multivariate Logistic regression analysis showed that hypertension history,Hunt-Hess classification at grade Ⅲ to Ⅳ and CT-Fisher classification at grade 3 to 4 were independent risk factors for poor prognosis in ACRIA patients after IIE. Conclusion:IIE can obtain better embolization effect in treatment of ACRIA patients,which can improve nerve function of patients.However,hypertension history,Hunt-Hess classification at grade Ⅲ to Ⅳ and CT-Fisher classification at grade 3 to 4 are independent risk factors for poor prognosis,which should be paied attention to and actively prevented.