开颅动 脉瘤夹闭术患者的术后心血管不良事件及预后 :一项回顾 性队列研究

Outcomes of patients experiencing cardiovascular adverse events within 1 year following craniotomy for intracranial aneurysm clipping:a retrospective cohort study

目的探讨开颅动脉瘤夹闭术患者术后严重心血管不良事件对于其预后的影响。方法本研究为回顾性队列研究,收集2016年12月~2017年12月在中南大学湘雅医院行开颅动脉瘤夹闭术的患者,根据患者术后是否发生Clavien-Dindo分级Ⅱ级及以上的心血管不良事件,将患者分为CAE组和非CAE组。收集其围术期临床资料、住院期间不良事件和入出院时的神经系统相关功能评估,并随访患者术后1年的神经系统功能情况和死亡率。主要结局指标是术后1年的死亡。次要结局指标为术后1年格拉斯哥预后评分(GOS)、术后住院时间、术后重症监护病房住院时间、出院前格拉斯哥昏迷评分(GCS)。结果共有361例患者纳入本研究,其中CAE组20例(5.5%)、非CAE组341例。2组患者的人口统计学资料、临床病史或其他术后不良事件差异均无统计学意义(P>0.05)。CAE组术后1年死亡率(20.0%;95%CI:0.8%~39.2%)高于非CEA组(5.6%;95%CI:3.1%~8.0%;P=0.010)。多因素logistics回归分析显示在调整了年龄、性别、急诊入院、合并蛛网膜下腔出血、出血量、手术时间、动脉瘤部位和术前心血管病史后,术后Clavien-Dindo分级≥Ⅱ的CAEs仍与术后1年死亡率独立相关(OR=3.670;95%CI:1.037~12.992;P=0.044)。CAE组术后1年GOS也更低(P=0.002)。但两组在其他不良事件发生率、术后住院时间、ICU住院时间、出院时GCS等方面差异无统计学意义(P>0.05)。结论颅内动脉瘤夹闭术患者术后发生心血管不良事件可能是术后1年死亡率和致残率的危险因素。

Objective To investigate the impact of postoperative serious cardiovascular adverse events(CAE) on outcomes of patients undergoing craniotomy for intracranial aneurysm clipping. Methods This retrospective cohort study was conducted among the patients undergoing craniotomy for intracranial aneurysm clipping during the period from December, 2016 to December, 2017, who were divided into CAE group and non-CAE group according to the occurrence of Clavien-Dindo grade≥Ⅱ CAEs after the surgery. The perioperative clinical characteristics of the patients, complications and neurological functions during hospitalization, and mortality and neurological functions at 1 year postoperatively were evaluated. The primary outcome was mortality within 1 year after the surgery. The secondary outcomes were Glasgow outcome scale(GOS) score at 1year, lengths of postoperative hospital and intensive care unit(ICU) stay, and Glasgow coma scale(GCS) score at discharge.Results A total of 361 patients were enrolled in the final analysis, including 20(5.5%) patients in CAE group and 341 in the nonCAE group. No significant differences were found in the patients’ demographic characteristics, clinical history, or other postoperative adverse events between the two groups. The 1-year mortality was significantly higher in CAE group than in the non-CAE group(20.0% vs 5.6%, P=0.01). Logistics regression analysis showed that when adjusted for age, gender, emergency hospitalization, subarachnoid hemorrhage, volume of bleeding, duration of operation, aneurysm location, and preoperative history of cardiovascular disease, postoperative CAEs of Clavien-Dindo grade≥Ⅱ was independently correlated with 1-year mortality rate of the patients with an adjusted odds ratio of 3.670(95% CI: 1.037-12.992, P=0.04). The patients with CEA also had a lower GOS score at 1 year after surgery than those without CEA(P=0.002). No significant differences were found in the occurrence of other adverse events, postoperative hospital stay, ICU stay, or GCS scores at discharge between the two groups(P>0.05). Conclusion Postoperative CAEs may be a risk factor for increased 1-year mortality and disability in patients undergoing craniotomy for intracranial aneurysms.