介入栓塞治疗颅内动脉瘤患者术后预后不良的相关因素分析

Relevant factors for the poor prognosis in patients with intracranial aneurysm after interventional embolization

目的探讨介入栓塞术治疗颅内动脉瘤(IA)患者术后预后不良的相关因素。方法选取2016年2月至2018年2月间延安大学附属医院收治的行介入栓塞术治疗的93例IA患者,随访至2019年3月31日,采用哥斯拉预后量表(GOS)评估患者预后情况,采用单因素及Logistic多因素分析影响患者术后预后不良的因素。结果介入栓塞术后预后不良者8例(8. 6%),平均GOS得分(1. 84±0. 62)分;预后良好者85例(91. 4%),平均GOS得分(3. 46±1. 15)分,组间比较,差异均有统计学意义(均P <0. 01)。IA患者介入栓塞术后预后不良与介入时机、有无高血压、Fisher分级、肿瘤部位、瘤颈宽度及Hunt-Hess分级有关,差异均有统计学意义(均P <0. 05)。将单因素分析结果中有统计学意义的6个指标纳入多因素Logistic回归方程,高血压、Fisher分级、瘤颈宽度≥4. 5mm及Hunt-Hess分级为影响患者介入栓塞术后预后不良的独立危险因素,差异均有统计学意义(均P <0. 05)。结论影响IA患者介入栓塞术后预后的危险因素为高血压、Fisher分级、瘤颈宽度≥4. 5及Hunt-Hess分级,临床可通过监控以上指标选择合适的治疗方案,以提高手术成功率,减少预后不良发生率。

Objective To examine the related factors for poor prognosis after interventional embolization for intracranial aneurysm(IA).Methods A total of 93 patients with IA who underwent interventional embolization at Second Affiliated Hospital of Yan’an University from February 2016 to February 2018 were selected.They were followed up until March 31,2019.The prognosis of patients with IA was evaluated by Glasgow outcome scale(GOS).Univariate and logistic multivariate analysis were used to analyze the factors influencing the poor prognosis of patients with IA.Results The poor postoperative prognosis was observed in 8 patients(8.6%)(18/93),whose average GOS score was 1.84±0.62 and good postoperative prognosis was observed in 85 patients(91.4%)whose average GOS score was 3.46±1.15.The difference in GOS score was statistically significant(P<0.05).When six indexes from the results of interest in univariate analysis were included in multivariate analysis,it showed that hypertension,Fisher classification,neck width≥4.5 mm and Hunt-Hess classification were independent risk factors for poor prognosis in patients with IA.Conclusion The risk factors after interventional embolization in patients with IA are hypertension,Fisher classification,neck width≥4.5 and Hunt-Hess classification.In order to improve the success rate of operation and reduce the incidence of poor prognosis,the appropriate IA treatment scheme can be selected by monitoring the above indexes.