体积栓塞比对颅内动脉瘤破裂出血患者介入治疗预后的预测作用

Predictive effect of volume embolization ratio on prognosis of patients with ruptured intracranial aneurysms undergoinginterventional therapy

目的探讨体积栓塞比对颅内动脉瘤破裂出血患者介入治疗预后的预测作用。方法对80例颅内动脉瘤破裂出血患者的临床资料展开回顾,均实施介入治疗,均计算体积栓塞比。术后均跟踪随访,统计不良预后的发生情况,对比各项不良预后发生者和未发生者体积栓塞比差异,以Logistic回归分析探讨体积栓塞比与颅内动脉瘤破裂出血患者介入治疗不良预后的关系。结果本组患者中不良预后事件发生率为22.50%;术后再出血发生者体积栓塞比低于未发生者,复发者低于未复发者,死亡者低于存活者,总不良预后发生者低于预后良好者,对比差异均有统计学意义(P<0.05);预后不良者年龄>60岁、发病至入院时间>8h、颅内动脉瘤≥10mm、瘤颈>4mm、Hunt-Hess IV^V级、体积栓塞比<15%、术中破裂出血、术中出血量>100ml、并发颅内血肿、并发脑疝、并发颅内感染者构成比均高于预后良好者(P<0.05),经Logistic回归分析证实均为其独立危险因素(OR=4.993、5.936、2.812、5.441、4.674、4.121、4.023、5.517、4.707、6.253、4.302,P<0.05)。结论颅内动脉瘤破裂出血患者介入治疗后不良预后事件发生风险高,且各项不良预后事件发生者体积栓塞比均较低,体积栓塞比<15%、年龄>60岁等均是患者不良预后事件发生的危险因素。

Objective To explore the predictive effect of volume embolization ratio on prognosis of patients with ruptured intracranial aneurysms undergoing interventional therapy.Methods The clinical data of 80 patients with ruptured intracranial aneurysms and hemorrhage were reviewed.All patients received interventional therapy,and the volume embolization ratio was calculated.All patients were followed up after operation to count the occurrence of adverse prognosis.The volume embolism ratios of patients with and without adverse prognosis were compared.Logistic regression analysis was used to investigate the relationship between volume embolization ratio and poor prognosis of interventional therapy in patients with ruptured intracranial aneurysms.Results The incidence of adverse prognostic events was 22.50%.The volume embolism ratio of patients with recurrent bleeding was lower than that of patients without recurrent bleeding,those with recurrent bleeding were lower than those without recurrent bleeding,those with dead bleeding were lower than those with survivors,and those with total adverse prognosis were lower than those with good prognosis.The differences were statistically significant(P<0.05).The patients with poor prognosis were older than 60 years old,the time from onset to admission>8 hours,intracranial aneurysms>10 mm,neck of aneurysms>4 mm,Hunt-Hess IV^V grade,volume embolism ratio<15%,intraoperative hemorrhage,intraoperative bleeding>100 ml,intracranial hematoma,cerebral hernia and intracranial complications were higher than those with good prognosis(P<0.05).Logistic regression analysis confirmed that all of them were independent risk factors(OR=4.993,5.936,2.812,5.441,4.674,4.121,4.023,5.517,4.707,6.253,4.302,P<0.05).Conclusion Patients with ruptured intracranial aneurysms and hemorrhage are at high risk of adverse prognostic events after interventional therapy,and the volume embolism ratio of patients with adverse prognostic events is lower.Volume embolism ratio<15%,age>60 and so on are risk factors for adverse prognosis events.