脑动脉瘤破裂患者栓塞术后脑血管痉挛的危险因素及预后

Risk factors and prognosis of cerebral vascular spasm in patients with ruptured cerebral aneurysm after embolization

目的探究脑动脉瘤破裂患者栓塞术后脑血管痉挛的危险因素及预后情况。方法收集2019-05—2022-05郴州市第一人民医院收治的120例脑动脉瘤破裂行栓塞术患者的资料,按术后情况分为脑血管痉挛组58例和无脑血管痉挛组62例。进行术后脑血管痉挛的单因素分析,采用多因素Logistic回归分析脑动脉瘤破裂患者改良Fisher分型、Hunt-Hess分级和动脉瘤直径与术后脑血管痉挛发生的关系,最后进行预后分析。结果2组高血压史和动脉瘤位置比较差异无统计学意义(P>0.05),脑血管痉挛组的改良Fisher分型Ⅱ级以上、Hunt-Hess分级Ⅲ级以上者多于无脑血管痉挛组,动脉瘤直径大于无脑血管痉挛组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,脑动脉瘤破裂患者改良Fisher分型Ⅱ级以上、Hunt-Hess分级Ⅲ级以上和动脉瘤直径大为术后脑血管痉挛发生的危险因素(P<0.05)。脑血管痉挛组的总不良事件发生率为18.97%,高于无脑血管痉挛组的3.23%(P<0.05)。结论脑动脉瘤破裂患者栓塞术后脑血管痉挛与出血量大小、神经功能损伤以及动脉瘤直径大小相关,且能增加不良事件的风险,需及时预防。

Objective To investigate the risk factors and prognosis of cerebral vascular spasm in patients with ruptured cerebral aneurysm after embolization.Methods The data of 120 patients with ruptured cerebral aneurysms who underwent embolization in the hospital from May 2019 to May 2022 were retrospectively collected.According to postoperative condition,the patients were divided into cerebral vascular spasm group(n=58)and non-cerebral vascular spasm group(n=62).Univariate analysis of postoperative cerebral vascular spasm was performed,and multivariate Logistic regression analysis was conducted to discuss the relationship of modified Fisher classification,Hunt-Hess classification and aneurysm diameter with postoperative cerebral vascular spasm in patients with ruptured cerebral aneurysms.The prognosis was evaluated.Results There was no significant difference between the groups in the history of hypertension and the location of aneurysm(P>0.05).There were more patients with modified Fisher gradeⅡand above,Hunt-Hess gradeⅢand above in the cerebral vascular spasm group than in the non-cerebral vascular spasm group.The diameter of the aneurysm was greater than that in the non-cerebral vascular spasm group(P<0.05).Multivariate Logistic regression analysis showed that modified Fisher gradeⅡand above,Hunt-Hess gradeⅢand above,and large aneurysm were risk factors for postoperative cerebral vascular spasm in patients with ruptured cerebral aneurysms(P<0.05).The total incidence of adverse events in the cerebral vascular spasm group after embolization(18.97%)was higher than that in the non-cerebral vascular spasm group(3.23%)(P<0.05).Conclusion Cerebral vascular spasm in patients with ruptured cerebral aneurysm after embolization is related to bleeding volume,neurological impairment and aneurysm diameter which are risk factors of adverse events,which deserves attention.