颅内动脉瘤破裂后血管内栓塞和脑室外引流治疗后病情持续恶化的相关危险因素分析

Risk factors for progressive deterioration of ruptured intracranial aneurysm after endovascular embolization and external ventricular drainage

目的探讨颅内动脉瘤破裂后血管内栓塞和脑室外引流治疗后病情持续恶化的相关危险因素。方法纳入167例经血管内治疗的破裂动脉瘤,其中有61例行脑室外引流术,61例中有38例患者预后较好,23例预后不良。回顾性分析38例好转患者与23例预后不良患者的临床资料,先进行单因素分析相关危险因素,再通过多因素Logistic进行分析,对颅内动脉瘤破裂经治疗后病情持续恶化的相关因素进行全面分析,所得数据经统计学分析差异。结果经单因素分析显示,两组格拉斯哥昏迷评分(GCS)、Hunt-Hess分级、Fisher分级、术后初始ICP、每日术后引流液5个危险因素在两组间比较差异有统计学意义(P<0.05);经二元Logistic多因素分析显示每日术后引流液少和Fisher分级高为颅内动脉瘤破裂后血管内栓塞和脑室外引流治疗后病情持续恶化的独立危险因素(P<0.05)。结论低GCS评分、Hunt-Hess分级高、Fisher分级高、术后初始ICP高、每日术后引流液少是颅内动脉瘤破裂经治疗后病情持续恶化的重要危险因素,每日术后引流液少和Fisher分级高是预后不良的独立危险因素。

Objective To investigate the risk factors for progressive deterioration of ruptured intracranial aneurysm after treatment of endovascular embolization and external ventricular drainage.Methods 167 cases of ruptured aneurysms treated by intravascular therapy were included,of which 61 cases underwent extraventricular drainage.Of the 61 cases,38 cases had a good prognosis and 23 cases had a poor prognosis.The clinical data of 38 improved patients and 23 patients with poor prognosis were analyzed retrospectively.The related risk factors were analyzed by univariate analysis,and then the related factors of continuous deterioration of intracranial aneurysm rupture after treatment were analyzed by multivariate logistic analysis.The data were statistically analyzed.Results By univariate analysis,the differences of these five risk factors,Glasgow Coma Score(GCS),Hunt-Hess grade,Fisher grade,initial postoperative ICP and postoperative drainage fluid per day,between the two groups had statistically significant differences(P<0.05).By multivariate logistic analysis,less postoperative drainage fluid per day and high Fisher grading were the independent risk factors for progressive deterioration of intracranial aneurysm ruptured after treatment of endovascular embolization and external ventricular drainage(P<0.05).Conclusion Low GCS score,high Hunt-Hess grade,high Fisher grade,high initial ICP after operation and less postoperative drainage fluid per day are important risk factors for the progressive deterioration of intracranial aneurysm rupture after treatment of endovascular embolization and external ventricular drainage.Less postoperative drainage fluid per day and high Fisher grade are independent risk factors for poor prognosis.