颅内动脉瘤患者外科夹闭手术治疗预后不良的危险因素分析

Risk factors for poor prognosis of surgical clipping for intracranial aneurysm

目的探讨颅内动脉瘤(IA)患者外科夹闭手术治疗预后不良的危险因素。方法回顾性分析2018年6月至2021年6月于信阳市中心医院行外科夹闭手术治疗的66例IA患者的临床及随访资料,以术后1年改良Rankin评分(mRS)结果分为预后良好(0~2分)和预后不良(3~6分),分析不同预后患者的临床资料差异,经多因素Logistic回归分析确定影响患者预后的风险因素。结果66例患者(共81个动脉瘤)中完全夹闭73个,大部分夹闭9个,随访截止时,预后良好53例,预后不良13例(含死亡2例);预后不良者>60岁、吸烟史、Hunt-Hess分级高级别(Ⅲ~Ⅴ级)、CT Fisher分级高级别(Ⅱ~Ⅳ级)、后循环动脉瘤、脑积水、迟发性脑梗死、血管痉挛的比例均高于预后不良者(P均<0.05);多因素Logistic回归分析结果显示,年龄(OR=1.388,95%CI=1.018~1.892,P<0.05)、Hunt-Hess分级(OR=13.237,95%CI=3.532~49.602,P<0.05)、CT Fisher分级(OR=6.347,95%CI=1.266~32.866,P<0.05)、责任动脉瘤位置(OR=1.872,95%CI=1.054~3.324,P<0.05)、迟发性脑梗死(OR=30.539,95%CI=2.116~440.769,P<0.05)是影响颅内动脉瘤外科夹闭手术患者预后的风险因素。结论老年、Hunt-Hess分级高级别、CT Fisher分级高级别、后循环动脉瘤、并发迟发性脑梗死的IA外科夹闭手术存在更高预后不良风险。

Objective To investigate the risk factors for poor prognosis of surgical clipping for intracranial aneurysm(IA).Methods The clinical and follow-up data from 66 patients with IA who underwent surgical clipping in Xinyang Central Hospital from June 2018 to June 2021 were retrospectively analyzed.According to the modified Rankin scale(mRS)score 1 year after surgery,the patients were divided into good prognosis(sRS 0-2)and poor prognosis(sRS 3-6).The differences in clinical data of patients with different prognoses were analyzed,and the risk factors affecting the prognosis of patients were determined by multivariate Logistic regression analysis.Results Among 81 aneurysms in the 66 patients,73 cases were completely clipped,and 9 cases were mostly clipped.At the end of follow-up,53 patients had good prognoses,and 13 patients had poor prognosis(including 2 cases of death).The proportions of patients with age>60 years,smoking history,high Hunt-Hess grade(Ⅲ-Ⅴ),high CT Fisher grade(Ⅱ-Ⅳ),posterior circulation aneurysm,hydrocephalus,delayed cerebral infarction and vasospasm among patients with good prognosis were higher than those among patients with poor prognosis(all P<0.05).Results of multivariate Logistic regression analysis showed that age(OR=1.388,95%CI=1.018-1.892,P<0.05),Hunt-Hess grading(OR=13.237,95%CI=3.532-49.602,P<0.05),CT Fisher grading(OR=6.347,95%CI=1.266-32.866,P<0.05),location of responsible aneurysm(OR=1.872,95%CI=1.054-3.324,P<0.05)and delayed cerebral infarction(OR=30.539,95%CI=2.116-440.769,P<0.05)were the risk factors affecting the prognosis of surgical clipping in patients with IA.Conclusions The risk of poor prognosis is higher among IA patients treated by surgical clipping,who were with the features of advanced age,high Hunt-Hess grade,high CT Fisher grade,posterior circulation aneurysm and delayed cerebral infarction.