老年大脑中动脉瘤患者手术预后危险因素分析

Risk factors for the poor outcome in elderly middle cerebral artery aneurysm patients after operation

目的分析老年大脑中动脉瘤(MCAA)患者手术预后危险因素。方法回顾性分析老年MCAA手术患者167例,根据格拉斯哥预后评分(GOS)分为预后良好组(GOS>3分)141例和预后不良组(GOS≤3分)26例。收集2组临床资料,采用logistic回归分析老年MCAA患者手术预后危险因素。结果预后不良组高血压比例明显高于预后良好组(P=0.033),2组SAH次数、Hunt-Hess分级、手术时机及术后并发症发生率比较,有统计学差异(P<0.05、P<0.01)。logistic回归分析显示,高血压、SAH 1次、SAH 2次、SAH 3次、Hunt-HessⅠ~Ⅲ级、Hunt-HessⅣ~Ⅴ级及术后并发症是影响老年MCAA患者手术预后的危险因素(95%CI:1.167~8.416,P=0.000;95%CI:1.226~4.017,P=0.018;95%CI:1.498~5.034,P=0.000;95%CI:1.502~5.743,P=0.000;95%CI:2.429~7.465,P=0.000;95%CI:2.874~8.041,P=0.000;95%CI:2.485~6.297,P=0.000)。结论高血压、SAH次数、Hunt-Hess分级及术后并发症是影响老年MCAA患者手术预后的危险因素,应积极控制。

Objective To analyze the risk factors for the poor outcome in elderly MCAA patients after operation.Methods One hundred and sixty-seven elderly MCAA patients were divided into good outcome group or GOS>3 group(n=141)and poor outcome group or GOS≤3 group(n=26).Their clinical data were recorded.The risk factors for the poor outcome in elderly MCAA patients after operation were analyzed by logistic regression analysis.Results The incidence of hypertension was significantly higher in poor outcome group than in good outcome group(P=0.033).Significant difference was detected in Hunt-Hess grading,operation time and postoperative complications between the two groups(P<0.05,P<0.01).Logistic regression analysis showed that hypertension,SAH frequency,Hunt-Hess grading and postoperative complications were the risk factors for the poor outcome in elderly MCAA patients(95%CI:1.167-8.416,P=0.000;95%CI:1.226-4.017,P=0.018;95%CI:1.498-5.034,P=0.000;95%CI:1.502-5.743,P=0.000;95%CI:2.429-7.465,P=0.000;95%CI:2.874-8.041,P=0.000;95%CI:2.485-6.297,P=0.000).Conclusion Hypertension,SAH frequency,Hunt-Hess grading and postoperative complications are the risk factors for the poor outcome in elderly MCAA patients,which suggests that hypertension,SAH frequency,Hunt-Hess grading and postoperative complications should be controlled in elderly MCAA patients.