高龄老年动脉瘤性蛛网膜下腔出血患者的介入治疗及预后影响因素

Surgical treatment strategies and risk factors for aneurysmal subarachnoid hemorrhage in the elderly patients

目的探讨高龄老年患者动脉瘤性蛛网膜下腔出血的治疗策略及预后的影响因素,及其对预后的评估价值。方法回顾性收集安徽医科大学第一附属医院神经外科自2018年11月至2020年9月收治的高龄老年患者动脉瘤性蛛网膜下腔出血患者的临床资料,包括性别、年龄、既往史、动脉瘤的数量、Hunt-Hess分级、住院日等。将患者分为预后良好组及预后不良组,利用统计学方法研究患者预后的危险因素,绘制受试者工作特征曲线(ROC)了解各危险因素对患者预后的评估价值。结果高龄老年aSAH患者37例作为研究对象,其中男性4例,女性33例,年龄范围65~87岁,年龄(70.3±4.74)岁。37例患者住院时间为5~66天,平均(19.95±12.03)天。26例为单个动脉瘤,9例为两个动脉瘤,2例为三个动脉瘤。瘤颈宽度从0.8 mm到9.05 mm,平均瘤颈3.44±1.60 mm。预后不同的两组在年龄、瘤颈宽度及平均住院日之间无统计学差异(P>0.05),而入院时的Hunt-Hess分级有统计学差异(P<0.05),是影响预后的危险因素,Hunt-Hess分级对不良预后评估的AUC为:0.867,最佳截断值分别为3.5。结论血管内介入治疗对高龄老年患者动脉瘤性蛛网膜下腔出血的治疗安全有效,Hunt-Hess分级是影响高龄老年患者动脉瘤性蛛网膜下腔出血预后的危险因素,能够对预后起判断作用。

Objective To explore the surgical treatment strategies and risk factors of aneurysmal subarachnoid hemorrhage(aSAH) in elderly patients.Methods Retrospectively collected clinical data of elderly patients with aSAH who were admitted to the Department of Neurosurgery of the First Affiliated Hospital of Anhui Medical University from November 2018 to September 2020.The collected clinical data included gender and age, clinical history, numbers of aneurysms, Hunt-Hess classification, hospitalization days, etc.The patients were divided into the good prognosis group and the poor prognosis group.The risk factors of the patient’s prognosis were studied by statistical methods, and the receiver operating characteristic curve(ROC) was drawn to understand the evaluation value of each risk factor to the patient’s prognosis.Results 37 elderly patients with aSAH were taken as the research objects, including 4 males and 33 females, ranging in age from 65 to 87 years old and(70.3±4.74) years old.The hospital stay of 37 patients was 5 to 66 days, with an average of(19.95±12.03) days.26 cases were a single aneurysm, 9 cases were two aneurysms, and 2 cases were three aneurysms.The width of the aneurysm neck ranges from 0.8 mm to 9.05 mm, with an average aneurysm neck of 3.44±1.60 mm.There was no statistical difference between the two groups with different prognosis in age, tumor neck width and average hospital stay(P>0.05),while the Hunt-Hess classification at admission was statistically different(P<0.05),which is a risk affecting the prognosis factors, Hunt-Hess classification for poor prognosis assessment AUC is 0.867,the best cut-off value is 3.5.Conclusion Endovascular interventional therapy is safe and effective for the treatment of aSAH in elderly patients.Hunt-Hess classification is a risk factor affecting the prognosis of aSAH in elderly patients, and can judge the prognosis effect.