颅内动脉瘤术后发生大面积脑梗死的危险因素分析

Analysis on the risk factors of massive cerebral infarction after intracranial aneurysm surgery

目的分析颅内动脉瘤术后患者发生大面积脑梗死的危险因素,提高临床医师对该疾病的认识。方法回顾性分析2010年1月1日至2020年12月31日贺州市人民医院收治的238例颅内动脉瘤患者的临床资料,其中接受介入栓塞治疗131例,开颅夹闭术治疗107例。13例患者术后发生大面积脑梗死(预后不良组),其余225例患者预后良好(预后良好组)。采用多因素logistic回归分析患者术后发生大面积脑梗死的危险因素。结果与预后良好组相比,预后不良组世界神经外科联合会(WFNS)分级为Ⅳ~Ⅴ级、改良Fisher分级为Ⅳ级,以及动脉瘤类型为多发动脉瘤(MSA)、不规则颈动脉瘤的人数比例更大;术中动脉瘤夹重新塑型夹闭、临时夹闭和动脉瘤破裂的发生率更高;动脉瘤最大径、大小比更大,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,更大的动脉瘤直径(OR=1.052)和不规则颈部动脉瘤(OR=3.413)是术后发生脑梗死的独立危险因素(P<0.05)。结论不规则颈动脉瘤和动脉瘤直径大是颅内动脉瘤患者术后发生大面积脑梗死的危险因素,临床医师应对该类患者予以重视,降低术后不良事件发生的风险。

Objective To analyze the risk factors of massive cerebral infarction in patients after intracranial aneurysm surgery,and to improve clinicians′understanding of the disease.Methods The clinical data of 238 patients with intracranial aneurysm who were admitted to Hezhou People′s Hospital from January 1,2010 to December 31,2020 were retrospectively analyzed.Among the 238 patients,131 patients received interventional embolization and 107 patients underwent craniotomy and clipping.Thirteen patients developed massive cerebral infarction after surgery(the poor prognosis group),and the rest 225 patients had a good prognosis(the good prognosis group).Multivariate logistic regression was used to analyze the risk factors of massive cerebral infarction in the patients after intracranial aneurysm surgery.Results Compared with the good prognosis group,the poor prognosis group had a greater proportion of the patients with World Federation of Neurosurgical Societies(WFNS)gradesⅣtoⅤ,modified Fisher gradeⅣ,multiple aneurysm sacs(MSA)aneurysm type and irregular carotid aneurysm.Compared with those in the good prognosis group,the incidence rates of intraoperative aneurysm clip remodeling,temporary clipping and aneurysm rupture in the poor prognosis group were higher.The maximum diameter of the aneurysm and the size ratio in the poor prognosis group were larger than those in the good prognosis group,and the differences were statistically significant(P<0.05).The results of multivariate logistic regression analysis showed that larger aneurysm diameter(OR=1.052)and irregular carotid aneurysm(OR=3.413)were the independent risk factors for postoperative cerebral infarction(P<0.05).Conclusion Irregular carotid aneurysm and large aneurysm diameter are the risk factors for postoperative massive cerebral infarction in the patients with intracranial aneurysm.Clinicians should pay attention to such patients to reduce the risk of postoperative adverse events.