颅内破裂动脉瘤栓塞术中再发破裂事件风险分析

Risk factors for rerupture events in embolization of ruptured aneurysm

目的探讨血管内介入栓塞治疗老年动脉瘤性蛛网膜下腔出血过程中发生术中再破裂(IPR)的风险因素。方法选择2016年6月~2019年9月收治的老年动脉瘤性蛛网膜下腔出血行血管内介入栓塞治疗患者278例,根据是否发生IPR分为IPR组13例和无IPR组265例,回顾性分析患者基本资料,多因素logistic回归分析IPR的危险因素。结果278例患者中,IPR 13例,IPR发生率为4.7%。IPR组高血压、动脉瘤<5 mm、动脉瘤形状不规则、术中脑血管痉挛比例和动脉瘤高与动脉瘤颈宽度的比值(AR)明显高于无IPR组(P<0.05)。多因素logistic回归分析显示,高血压、动脉瘤<5 mm、AR和术中脑血管痉挛是IPR的危险因素(P<0.05)。结论血管内介入栓塞治疗中IPR的危险因素可能是小动脉瘤、较高的AR、高血压和术中脑血管痉挛等。

Objective To study the risk factors for rerupture events during endovascular embolization of ruptured aneurysm(RA)in elderly patients with aneurismal SAH.Methods Two hundred and seventy-eight elderly SAH patients who underwent endovascular embolization of RA in our hospital were divided into intraoperative rerupture(IPR)group(n=13)and IPR-free group(n=265).Their baseline clinical data were retrospectively analyzed.The risk factors for IPR were analyzed by multivariate logistic regression analysis.Results IPR occurred in 13 out of the 278 SAH patients with an incidence of 4.7%.The incidence of hypertension,aneurysm size<5 mm,irregular morphology of aneurysm,intraoperative cerebral vasospasm and AR value were significantly higher in IPR group than in IPR-free group(P<0.05).Multivariate logistic regression analysis showed that hypertension,aneurysm size<5 mm,AR value,and intraoperative cerebral vasospasm were the risk factors for IPR in elderly SAH patients(P<0.05).Conclusion Small aneurysm,high AR value,hypertension and intraoperative cerebral vasospasm are the risk factors for IPR during endovascular embolization of RA in elderly SAH patients.