术前分级与手术时机对颅内动脉瘤患者介入下血管内栓塞术预后的影响

Influence of preoperative grading and timing of surgery on the prognosis of endovascular embolotherapy for intracranial aneurysms

目的探讨不同手术时机、不同Fisher分级以及不同Hunt-Hess分级对颅内动脉瘤患者介入下血管内栓塞术预后的影响。方法回顾性分析2021年1月年2023年1月南阳市中心医院收治的92例颅内动脉瘤患者的临床资料,以上患者均接受血管内栓塞术手术治疗,并于术后6个月随访患者的预后情况,依据改良Rankin量表(mRS)评分将患者分为预后良好组(58例)及预后不良组(34例)。对两组患者术前手术时间、术前Fisher分级以及术前Hunt-Hess分级的数据进行分析。结果两组性别、糖尿病、高血压、动脉瘤长径以及瘤颈比较差异未见统计学意义(P>0.05),但两组手术时间、Fisher评级和术前Hunt-Hess评级比较差异有统计学意义(P<0.05)。多元Logistic回归分析结果显示,手术时机、Fisher分级以及术前Hunt-Hess分级是影响颅内动脉瘤患者接受血管内栓塞治疗后预后不良的独立风险因素(P<0.05)。结论手术时机的选择、不同术前Fisher分级以及不同术前Hunt-Hess分级与颅内动脉瘤患者接受血管内栓塞术治疗后的预后有关,其中晚期手术、术前Fisher分级与Hunt-Hess分级较高是术后预后较差的独立危险因素。

Objective To investigate the influence of surgical timings,Fisher grades and Hunt-Hess grades on the prognosis of endovascular embolotherapy on intracranial aneurysms.Methods The clinical data of 92 patients with intracranial aneurysms admitted to Nanyang Central Hospital from January 2021 to January 2023 were retrospective analyzed.All patients underwent endovascular embolotherapy and were followed up for 6 months to assess prognostic outcomes.According to the modified Rankin scale(mRS)score,the selected patients were divided into a good prognosis group(58 cases)and a poor prognosis group(34 cases).Preoperative surgical timing,Fisher grades,and Hunt-Hess grades of the two groups were analyzed.Results There were no significant statistical differences in gender,diabetes,hypertension,aneurysm size,and neck aspect between the two groups(P>0.05).However,there was a statistically significant difference in surgical time,Fisher grade,and preoperative Hunt-Hess grade between the two groups(P<0.05).Results of multivariate logistic regression analysis indicated that the timing of surgery,Fisher grade,and preoperative Hunt-Hess grade were independent risk factors for poor prognosis after endovascular embolotherapy in patients with intracranial aneurysms(P<0.05).Conclusions The choice of surgical timing,preoperative Fisher grades,and preoperative Hunt-Hess grades are associated with the prognosis of patients with intracranial aneurysms after endovascular embolotherapy.Late-stage surgery,higher preoperative Fisher grade,and higher preoperative Hunt-Hess grade are independent risk factors for poorer prognosis.