早期显微手术夹闭瘤颈治疗颅内动脉瘤的疗效及动脉瘤术中破裂出血的危险因素

Risk Factors of Early Microsurgical Clipping of Cervical Neck for Treatment of Rupture and Hemorrhage Caused by Intracranial Aneurysm

目的 探讨早期显微手术夹闭瘤颈治疗颅内动脉瘤的疗效及动脉瘤术中破裂出血的危险因素。方法 选择颅内未破裂动脉瘤患者160例,将接受早期显微手术夹闭瘤颈治疗手术治疗过程中动脉瘤破裂患者80例作为观察组,未破裂80例作为对照组。分析其临床疗效及引发术中破裂的危险因素。结果 与对照组比较,观察组术后第14天视觉与执行功能评分、注意力评分、语言评分、延迟回忆评分、定向评分、总分显著降低(P<0.05)。观察组患者术后GOS评分良好率65.0%,低于对照组的80.0%(P<0.05)。动脉瘤再破裂、感染、脑积水及脑血管痉挛为常见并发症,观察组的并发症发生率为28.75%,高于对照组的7.50%(P<0.05)。Logistic回归分析显示,不规则形态、前交通动脉瘤为动脉瘤术中破裂的独立危险因素,支架植入术是动脉瘤术中破裂的保护因素。结论 动脉瘤未破裂出血患者接受早期显微镜手术夹闭瘤颈治疗可明显改善预后,并发症发生率低。颅内动脉瘤术中破裂的危险因素较多,需引起临床注意。

Objective To investigate the risk factors of early microsurgical clipping of the neck for the treatment of ruptured hemorrhage caused by intracranial aneurysms.Methods A total of 160 patients with intracranial unruptured aneurysms were enrolled.All patients underwent early microsurgical clipping of the neck,80 patients with intraoperative rupture were in the observation group,and 80 patients with unruptured intraoperatively were in the control group.To analyze its clinical efficacy and risk factors for intraoperative rupture.Results Compared with the control group,the visual and executive function scores,attention scores,language scores,delayed recall scores,directional scores,and total scores were decreased on the 14 th day after operation(P<0.05).The good rate of postoperative GOS score was 65.0% in the observation group,which was lower than that in the control group(80.0%)(P<0.05).Aneurysm re-rupture,infection,hydrocephalus and cerebral vasospasm were common complications.The incidence of complications in the observation group was 28.75%,which was higher than that of the control group(7.50%)(P<0.05).Logistic regression analysis showed that irregular morphology,and anterior communicating aneurysm were independent risk factors for intraoperative rupture of aneurysms.Stenting was a protective factor for intraoperative rupture of aneurysms.Conclusion Patients with unruptured aneurysm undergoing early microsurgical clipping of the neck can significantly improve the prognosis and the incidence of complications is low.There are many risk factors for intraoperative rupture of intracranial aneurysms,which require clinical attention.