颅内动脉瘤夹闭术中动脉瘤破裂的危险因素分析

Risk factors of aneurysm rupture during clipping in patients with intracranial aneurysm

目的探讨颅内动脉瘤病人夹闭术中动脉瘤破裂的危险因素。方法回顾性分析2009年7月至2018年7月夹闭术治疗的296例颅内动脉瘤的临床资料。采用多因素logistic回归分析检验术中动脉瘤破裂的影响因素。结果296例中,夹闭术中发生动脉瘤破裂59例,未破裂237例。多因素logistic回归分析,年龄≥60岁、Hunt-Hess分级Ⅲ~Ⅴ级、发病至手术时间>3 d、手术器械不佳及手术操作不细致、动脉瘤瘤体血管弹性差及瘤体粘连是术中动脉瘤破裂的独立危险因素(P<0.05)。结论高龄、Hunt-Hess分级高、发病至手术时间长、分离动脉瘤颈操作不细致、动脉瘤瘤体粘连为颅内动脉瘤病人夹闭术中动脉瘤破裂的主要危险因素。

Objective To investigate the risk factors of aneurysm rupture during clipping in patients with intracranial aneurysm.Methods The clinical data of 296 patients with intracranial aneurysm treated by clipping from July,2009 to July,2018 were retrospectively analyzed.Multivariate logistic regression analysis was used to examine the influencing factors of aneurysm rupture during clipping.Results Of 296 patients,59 patients had aneurysm ruptures and 237 unruptured aneurysms during clipping.Multivariate logistic regression analysis showed that age≥60 years,Hunt-Hess gradeⅢtoⅤ,time of onset to surgery>3 d,inadequate surgical instruments and operations,poor aneurysm vascular elasticity,and aneurysm adhesion are independent risk factors for aneurysm rupture during intracranial aneurysm clipping(P<0.05).Conclusions Old age,high Hunt-Hess grade,long time from onset to surgery,intricate operation for separating aneurysm neck,and adhesion of aneurysm body are the main risk factors for aneurysm rupture during clipping.