后交通动脉瘤破裂致更高出血程度的相关因素分析

Analysis on related factor of higher degree of hemorrhage due to ruptured posterior communicating artery aneurysm

目的探讨后交通动脉瘤(PCoAA)破裂后导致更高出血程度的危险因素。方法回顾性分析162例PCoAA破裂患者的临床资料,根据患者入院时CT表现,采用改良Fisher分级法将其分为高mFS组(69例)和低mFS组(93例)。通过比较2组患者的临床资料和动脉瘤形态学特点,采用单因素分析及Logistic回归分析确定造成PCoAA破裂后更高出血程度的危险因素。结果单因素分析显示,2组患者年龄、入院时舒张压、入院时血清镁含量比较差异有统计学意义(P<0.05),而性别、高血压病史、动脉粥样硬化、入院时收缩压、动脉瘤大小、瘤顶指向、瘤颈宽度、瘤高/瘤颈、动脉瘤形态(有无子囊)、是否合并胚胎型大脑后动脉(FPCA)组间比较差异无统计学意义(P>0.05);多因素Logistic回归分析显示,年龄(OR=2.555,95%CI1.204~5.423,P=0.015)和入院时血清镁含量(OR=0.070,95%CI0.016~0.301,P<0.001)与PCoAA破裂后出现高改良Fisher分级存在显著独立相关性。结论PCoAA患者的年龄及入院时血清镁含量与其动脉瘤破裂后出现高改良Fisher分级密切相关,需要临床密切关注。

Objective To investigate the risk factors of a higher degree of hemorrhage due to ruptured posterior communicating artery aneurysms(PCoAA).Methods The clinical data of 162 patients with ruptured PCoAA were analyzed retrospectively.According to the CT findings at admission,the patients were divided into high modified Fisher scale(mFS)group(n=69)and low mFS group(n=93)by modified Fisher score.By comparing the clinical data and the morphological characteristics of aneurysms between the two groups,univariate analysis and Logistic regression analysis were used to determine the risk factors of higher degree of hemorrhage caused by ruptured PCoAA.Results Univariate analysis showed that there were significant differences in the age,diastolic blood pressure and serum magnesium level between the two groups(P<0.05),while no significant difference was found in the gender,history of hypertension,atherosclerosis,systolic blood pressure at admission,aneurysm size,orientation of tumor apex,aneurysm neck width,aneurysm height/aneurysm neck,aneurysm morphology(with or without ascus),or whether there was a combined fetal-type posterior cerebral artery(FPCA)between the two groups(P>0.05).Multivariate Logistic regression analysis showed that the age(OR=2.555,95%CI:1.204~5.423,P=0.015)and serum magnesium level(OR=0.070,95%CI:0.016~0.301,P<0.001)were associated with high modified Fisher grade following rupture of aneurysms.Conclusion The age and serum magnesium level of patients with PCoAA seem to be closely related to the high modified Fisher grade after the rupture of aneurysms,which needs close clinical attention.