颅内前循环动脉瘤性蛛网膜下腔出血后认知功能障碍的影响因素及介入治疗效果分析

Influencing factors of cognitive dysfunction after intracranial anterior circulation aneurysmal subarachnoid hemorrhage and the effect of interventional therapy

目的探讨颅内前循环动脉瘤性蛛网膜下腔出血后认知功能障碍的影响因素及介入治疗效果。方法选取中国人民解放军联勤保障部队第九六〇医院2019年1月至2021年5月收治的500例颅内前循环动脉瘤性蛛网膜下腔出血患者为研究对象,根据入院时是否并发认知功能障碍将研究对象分为对照组(无认知功能障碍,347例)和观察组(并发认知功能障碍,153例)。采用随机数字表法将观察组患者分为夹闭组(63例)和介入组(90例),其中夹闭组给予动脉瘤夹闭术治疗,介入组给予介入栓塞术治疗。分析患者入院时的认知功能障碍发生情况以及并发认知功能障碍的影响因素。比较分析对照组与观察组患者的临床资料以及夹闭组与介入组患者手术前后的蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评分。结果500例患者中,153例入院时并发认知功能障碍,认知功能障碍发生率为30.60%。观察组患者Fisher分级≥3级、Hunt-Hess分级≥3级的比例均显著高于对照组(P<0.05),而入院时的格拉斯哥昏迷评分(Glasgow coma score,GCS)显著低于对照组(P<0.05)。多因素logistic回归分析结果显示,年龄、Fisher分级是颅内前循环动脉瘤性蛛网膜下腔出血患者并发认知功能障碍的独立影响因素(P<0.05)。术后1周,夹闭组与介入组患者的MoCA评分均显著高于术前(P<0.05),且介入组显著高于夹闭组(P<0.05)。结论颅内前循环动脉瘤性蛛网膜下腔出血后认知功能障碍的发生受患者的年龄、Fisher分级影响,且采用介入栓塞术治疗有助于改善患者的认知功能。

Objective To investigate the influencing factors of cognitive dysfunction after intracranial anterior circulation aneurysmal subarachnoid hemorrhage and the effect of interventional therapy.Method 500 patients with intracranial anterior circulation aneurysmal subarachnoid hemorrhage treated in the 960 Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army from January 2019 to May 2021 were selected.They were divided into observation group(153 cases with cognitive dysfunction)and control group(347 cases without cognitive dysfunction).And the patients in the observation group were randomly divided into clipping group(63 cases)and intervention group(90 cases).The clipping group was given aneurysm clipping and the intervention group was given interventional embolization.The incidence of cognitive dysfunction and the influencing factors of cognitive dysfunction were analyzed.The clinical data of the control group and the observation group and the MoCA scores of the clipping group and the intervention group before and after surgery were compared and analyzed.Result Among the 500 patients,153 patients with cognitive dysfunction,and the incidence of cognitive dysfunction was 30.60%.The proportions of Fisher grade≥3 and Hunt-Hess grade≥3 in observation group were significantly higher than those in control group(P<0.05),GCS was significantly lower than that in control group(P<0.05).Age and Fisher grade were independent influencing factors of cognitive dysfunction in patients with intracranial anterior circulation aneurysmal subarachnoid hemorrhage(P<0.05).One week after surgery,MoCA scores in clipping group and intervention group were significantly higher than those before surgery(P<0.05),and intervention group was significantly higher than clipping group(P<0.05).Conclusion Cognitive dysfunction after intracranial anterior circulation aneurysmal subarachnoid hemorrhage was affected by age and Fisher grade,and interventional embolization was helpful to improve cognitive function.