后交通动脉瘤所致动眼神经麻痹患者神经功能恢复的影响因素分析

Analysis of Influencing Factors for Neurological Recovery in Patients with Oculomotor Nerve Palsy Caused by Posterior Communicating Aneurysm

目的:探究后交通动脉瘤所致的动眼神经麻痹(OMNP)患者神经功能恢复的独立影响因素。方法:回顾性研究2016年1月—2022年1月天津市第一中心医院收治的104例因后交通动脉瘤所致OMNP患者,查阅电子归档病历及追踪随访信息;应用Kaplan-Meier生存分析法和Cox比例风险回归模型,探究各因素随时间延长直至到达随访终点的结局走势,测算独立影响因素及其对预后结局的危险比率。结果:在单因素分析下,发病-手术时间、术前OMNP程度、改良Fisher分级、Hunt-Hess分级、高血压分级为可疑影响因素(P<0.05),术式不是影响术后OMNP完全恢复的可疑影响因素(P>0.05);在多因素分析下,发病-手术时间、改良Fisher分级、术前OMNP程度是影响患者动眼神经麻痹完全恢复的独立影响因素(P<0.05)。结论:2 d内的早期手术干预是破裂型后交通动脉瘤所致术后动眼神经麻痹患者完全恢复的独立保护因素;介入栓塞术同手术夹闭相比无显著性差异;术前对Fisher分级和动眼神经麻痹临床表现评估,有助于改善患者预后。

Objective:To explore the independent influencing factors of neurological function recovery in patients with oculomotor nerve palsy(OMNP)due to posterior communicating artery aneurysm.Method:A total of 104 patients with OMNP due to posterior communicating artery aneurysm admitted to Tianjin First Central Hospital from January 2016 to January 2022 were retrospectively studied,and electronic archived medical records and follow-up information were reviewed.Kaplan-Meier survival analysis and Cox proportional risk regression model were used to explore the outcome trend of each factor over time until the end of follow-up,and the independent influencing factors and their risk ratio for prognostic outcome were measured.Result:Under univariate analysis,the incidence-operation time,preoperative OMNP degree,modified Fisher grade,Hunt-Hess grade and hypertension grade were suspected influencing factors(P<0.05),but the operation type was not suspected influencing factors on the complete recovery of postoperative OMNP(P>0.05).Under multivariate analysis,the time of onset and operation,modified Fisher grade and preoperative OMNP degree were independent factors affecting the complete recovery of oculomotor nerve palsy(P<0.05).Conclusion:Early surgical intervention within 2 d is an independent protective factor for complete recovery of patients with postoperative oculomotor paralysis due to ruptured posterior communicating aneurysm.There was no significant difference between interventional embolization and surgical clipping group;Preoperative evaluation of Fisher grade and clinical manifestations of oculomotor nerve palsy can help improve patient prognosis.