老年颅内动脉瘤破裂患者预后的影响因素

Factors influencing the prognosis of elderly patients with ruptured intracranial aneurysms

目的分析可能影响老年颅内动脉瘤破裂患者预后的危险因素。方法回顾性分析281例老年(65岁以上)颅内动脉瘤病例资料,均为颅内单一动脉瘤破裂,采用显微外科手术或介入栓塞手术治疗。采用改良Rankin量表(modified Rankin Scale,mRS)评价预后,预后良好为mRS 0~2分,预后不良为mRS 3~6分。结果术后随访2年,预后良好组216例,预后不良组65例。年龄、住院时间、Hunt-Hess分级、脑室出血、脑血管痉挛、手术(方式、时机与时间)、术中出血量及术后并发症(脑积水、颅内感染、肺部感染及神经系统相关症状),两组差异具有统计学意义(均P<0.05)。手术时间(OR=1.723,95%CI:1.115~2.662)、脑积水(OR=3.907,95%CI:1.768~8.636)、颅内感染(OR=3.383,95%CI:1.189~9.624)、肺部感染(OR=10.157,95%CI:4.371~23.604)与Hunt-Hess分级(OR=2.139,95%CI:1.373~3.334)是影响预后的独立危险因素。结论影响老年颅内动脉瘤破裂患者预后的因素比较复杂,包括年龄、Hunt-Hess分级、脑室出血、脑血管痉挛、手术(方式、时机与时间)、术中出血量、术后并发症等。其中Hunt-Hess分级、脑积水、颅内感染、肺部感染及手术时间对预后影响较大。

Objective To analyze the potential risk factors that may affect the prognosis of elderly patients with ruptured intracranial aneurysms.Methods The clinical data of 281 elderly patients(aged over 65)with ruptured intracranial single aneurysms,all of whom underwent either microsurgery or interventional embolization,were analyzed retrospectively.The modified Rankin Scale(mRS)was utilized to assess prognosis,with scores of 0-2 indicating good prognosis and 3-6 indicating poor prognosis.Results After a 2-year follow-up,216 patients were categorized into the good prognosis group,and 65 patients into the poor prognosis group.Statistically significant differences were observed between the two groups in age,hospital stay,Hunt-Hess grade,intraventricular hemorrhage,cerebral vasospasm,surgical factors(approach,timing,and duration),intraoperative blood loss,and postoperative complications(hydrocephalus,intracranial infection,lung infection,and neurological symptoms)(all P<0.05).Independent risk factors for prognosis included operative time(OR=1.723,95%CI:1.115-2.662),hydrocephalus(OR=3.907,95%CI:1.768-8.636),intracranial infection(OR=3.383,95%CI:1.189-9.624),lung infection(OR=10.157,95%CI:4.371-23.604),and Hunt-Hess grade(OR=2.139,95%CI:1.373-3.334).Conclusions The factors influencing the prognosis of elderly patients with ruptured intracranial aneurysms are complex,including age,Hunt-Hess grade,intraventricular hemorrhage,cerebral vasospasm,surgical factors(approach,timing,and duration),intraoperative blood loss,and postoperative complications.Among these,Hunt-Hess grade,hydrocephalus,intracranial infection,lung infection,and operative time have a substantial impact on prognosis.