血管内栓塞术联合腰大池引流治疗颅内动脉瘤

Effect of endovascular embolization eombined with lumbar cistern drainage on patients with Intracranial aneurysms and analysis of prognostic factors

目的探讨血管内栓塞术联合腰大池引流对颅内动脉瘤患者的治疗效果,分析影响手术患者预后的因素。方法选取2016年3月年2018年5月间在我院神经外科接受治疗的92例颅内动脉瘤患者作为研究对象进行回顾性研究,根据治疗方式将其分为对照组(血管内栓塞术+常规腰椎穿刺引流,51例)和观察组(血管内栓塞术+腰大池引流,41例),比较两组患者的治疗效果。对观察组患者进行随访,根据格拉斯哥预后评分(Glasgow outcome score,GOS)评价预后,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回归分析筛选影响患者预后的因素。结果观察组患者术后脑血管痉挛、脑积水的发生率均显著低于对照组(χ2=4.824,5.716;P=0.028,0.017);重复测量方差分析显示,栓塞术后不同时间和组间脑脊液红细胞计数、颅内压比较差异均存在统计学意义(F时间=138.19,88.70;F组间=301.95,161.12,P<0.001),且时间与组别间存在交互作用(F交互=462.23,224.73,P<0.001)。单因素分析显示,年龄、动脉瘤大小、栓塞术前Hunt-Hess分级、多发性动脉瘤、术后并发症与患者术后预后有关。多因素logistic回归分析显示,年龄、动脉瘤大小、术前Hunt-Hess分级、多发性动脉瘤、术后并发症是影响患者预后的独立影响因素。结论在血管内栓塞术的基础上联合腰大池引流治疗颅内动脉瘤效果要显著优于术后常规腰椎穿刺引流术,其可显著改善患者脑血管血流动力学指标,降低颅内压,从而明显降低患者术后脑血管痉挛和脑积水的发生率。此外,年龄、动脉瘤大小、术前Hunt-Hess分级、多发性动脉瘤、术后并发症是影响患者预后的独立影响因素,对其中可干预的因素进行有效控制可能有利于改善患者的预后。

Objective To investigate the therapeutic effect of endovascular embolization combined with lumbar cistern drainage on patients with intracranial aneurysms,and to analyze the factors influencing the prognosis of patients.Methods 92 patients with intracranial aneurysms were divided into control group(endovascular embolization combined with routine lumbar puncture drainage,51 cases)and observation group(endovascular embolization combined with lumbar cistern drainage,41 cases).The therapeutic effects were compared.The patients in the observation group were followed up,and the prognosis was evaluated,the patients were divided into good prognosis group and bad prognosis group.Univariate analysis and multivariate logistic regression analysis were used to screen the factors affecting the prognosis of patients.Results The incidence of cerebral vasospasm and hydrocephalus in the observation group were significantly lower than those in the control group(χ^2=4.824,5.716,P=0.028,0.017).Repeated measurement analysis of variance showed that there were statistically significant differences in the number of red blood cells in cerebrospinal fluid and intracranial pressure between groups at different times after embolization(F=138.19,88.70;F=301.95,161.12,P=0.001),and there was interaction between time and groups(F=462.23,224.73,P=0.001).Age,size of aneurysm,Hunt-Hess grade before embolization,multiple aneurysms and complications after embolization were independent factors affecting the prognosis of patients.Conclusion On the basis of endovascular embolization combined with lumbar cistern drainage for the treatment of intracranial aneurysms is significantly better than the routine lumbar puncture and drainage.In addition,age,aneurysm size,preoperative Hunt-Hess classification,multiple aneurysms and postoperative complications are independent factors affecting the prognosis of patients.