显微夹闭术与介入栓塞术治疗颅内动脉瘤的效果及预后不良危险因素分析

Analysis of effect of microclipping and interventional embolization on intracranial aneurysm and risk factors of poor prognosis

目的探究显微夹闭术与介入栓塞术治疗颅内动脉瘤的效果及分析预后不良危险因素。方法前瞻性选取2020年1月至2023年1月安阳市人民医院收治的颅内动脉瘤患者80例为研究对象,按随机数排秩法将患者分为研究组40例与对照组40例,对照组予以显微夹闭术治疗,研究组予以介入栓塞术治疗,比较两组治疗效果[恢复指标、相关细胞因子水平(MMP-9、ICAM-1、NF-kB)、神经功能(NIHSS评分)、日常生活功能(MBI评分)、并发症]与预后的差异,并分析预后不良危险因素。结果研究组手术用时、术中出血量、住院时长均低于对照组(P<0.05)。两组术后3个月MMP-9、ICAM-1、NF-kB与术前比较均降低(P<0.05);且研究组术后3个月MMP-9、ICAM-1、NF-kB均低于对照组(P<0.05)。重复测量方差分析结果显示,两组出院时、术后3个月NIHSS评分与术前相比均降低,MBI评分与术前相比均升高(P<0.05),且研究组出院时、术后3个月NIHSS评分、MBI评分升高降低幅度均优于对照组(P<0.05)。研究组总并发症发生率低于对照组(P<0.05)。等级资料秩和检验结果,两组预后状况(GOS评分)比较差异存在统计学意义(Z=5.279,P>0.05),且研究组预后良好率高于对照组(P<0.05)。二元logistic回归分析显示,年龄(≥60岁)、高血压、手术时机(晚期)、Fisher分级(3~4)、Hunt-Hess分级(Ⅲ~Ⅳ级)、AR(>2.0)是影响预后状况的危险因素(P<0.05)。结论介入栓塞术治疗颅内动脉瘤可有效提高患者神经功能与日常生活功能,改善预后,且安全性较好,但年龄、高血压、手术时机、Fisher分级、Hunt-Hess分级、AR均会影响其预后质量。

Objective To explore the effect of microclipping and interventional embolization in the treatment of intracranial aneurysm and analyze the risk factors of poor prognosis.Methods Eighty patients with intracranial aneurysms admitted to our hospital from January 2020 to January 2023 were prospectively selected as research objects.According to the random number rank method,the patients were divided into the study group(40 cases)and the control group(40 cases).The control group was treated with microclipped surgery,while the research group was treated with interventional embolization.The differences of therapeutic effect recovery indicators,related cytokine levels(MMP-9,ICAM-1,NF-kB),neurological function(NIHSS score),daily living function(MBI score),complications and prognosis between the two groups were compared,and the risk factors of poor prognosis were analyzed.Results The operation time,intraoperative blood loss and length of hospital stay in the study group were lower than those of the control group(P<0.05).MMP-9,ICAM-1 and NF-kB in both groups were decreased 3 months after surgery compared with those before surgery(P<0.05).In addition,MMP-9,ICAM-1 and NF-kB in the study group were lower than those of the control group 3 months after operation(P<0.05).The results of repeated measurement analysis of variance showed that the NIHSS score at discharge and 3 months after surgery was lower than that before surgery,and the MBI score was higher than that before surgery(P<0.05),and the increase and decrease of NIHSS score and MBI score at discharge and 3 months after surgery in the study group were better than those of the control group(P<0.05).The total complication rate of the study group was lower than that of the control group(P<0.05).The results of rank sum test showed that there was significant difference in GOS score between the two groups(Z=5.279,P>0.05),and the good prognosis rate of the study group was higher than that of the control group(P<0.05).Binary logistic regression analysis showed that age(≥60 years old),hypertension,surgical timing(late stage),Fisher grade(3-4),Hunt-Hess grade(II~IV),AR(>2.0)were the risk factors for the prognosis(P<0.05).Conclusion Interventional embolization in the treatment of intracranial aneurysm can effectively improve the neurological function and daily living function of patients,improve the prognosis with good safety,but age,hypertension,surgical timing,Fishers grade,Hunt-Hess grade,AR can affect the quality of prognosis.