摘要
目的动脉瘤术中破裂为颅内破裂动脉瘤栓塞治疗的严重并发症，一旦发生具有较高的致残和致死率，本研究的目的是分析其危险因素，总结术中动脉瘤破裂的治疗策略。方法回顾性分析532例颅内破裂动脉瘤患者的资料，采用单因素结合多因素方法分析颅内破裂动脉瘤发生术中破裂的危险因素，总结动脉瘤术中破裂的治疗策略。结果本组病人532例伴532枚破裂动脉瘤，发生术中动脉瘤破裂20例（3．8Vo）。单因素分析显示颅内动脉粥样硬化（P=0．010）、动脉瘤大小（2—16．464，P=0．000）、血管痉挛（P=0．004）是动脉瘤术中破裂的影响因素；多因素Logistic回归分析显示微小动脉瘤（OR，10．416；95％CI，1．797～32．212；P=0．013）、血管痉挛（OR，4．842；95％CI，1．633～14．354；P=0．004）、和颅内动脉粥样硬化（OR，3．652；95％CI，1．352～10．166；P=0．001）是颅内破裂动脉瘤栓塞术中动脉瘤破裂的独立危险因素。结论颅内动脉粥样硬化、微小动脉瘤、脑血管痉挛是血管内治疗颅内破裂动脉瘤发生术中破裂的独立危险因素；发生动脉瘤术中破裂后应立即静脉注射鱼精蛋白中和肝素并快速完成动脉瘤栓塞。
Objective Intraoperative rupture of aneurysms is a severe complication of coiling of intracranial anenrysms, which have high rate of disability and death. The purpose of this study was to an- alyze risk factors of intraoperative rupture of aneurysms, and explore techniques for treatment of the com- plication. Methods Endovascular treatment was performed in 532 ruptured intracranial aneurysms. Uni- variate analysis and multivariate logistic regression model were used to determine risk factors of intracra- nial aneurysms. Techniques for treatment of the complication were explored. Results A total of 532 pa- tients with 532 ruptured aneurysms were included in this study,and intraoperative rupture of aneurysms occurred in 20 patients （3.8% ）. Atherosclerosis （P = 0.010）, aneurysm size （2 = 16. 464, P = 0. 000）, vasospasm （P=0. 004） were effect factors of intraoperative rupture of aneurysms. Multivariate logistic regression analysis indicated that atherosclerosis （OR, 3. 652 ; 95 % CI, 1. 352 - 10. 166 ; P = 0. 001）, tiny aneurysm（OR,10. 416 ;95% CI,1. 797-32. 212;P=0. 013） ,vasospasm（OR,4. 842;95% CI,1. 633-14. 354;P=0.004）were independent risk factors of intraoperative rupture of aneurysms. Conclusion Ather- osclerosis,tiny aneurysm, vasospasm were independent risk factors of intraoperative rupture of aneu- rysms. Once intraoperative rupture of aneurysms happened,it was crucial to reverse immediately heparin anticoagulation with protamine sulfate and complete aneurysmal coiling quickly and accurately.
作者
顾大群
张扬
晁迎九
傅先明
陈昱
高歌
余舰
牛朝诗
Gu Daqun Zhang Yang Chao Yingjiu et al(Department of Neurosurgery , Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease, Anhui Provincial Stereotactic Neurosurgical Institute, 230001, Hefei, China)
出处
《立体定向和功能性神经外科杂志》
2016年第5期288-292,共5页
Chinese Journal of Stereotactic and Functional Neurosurgery
基金
安徽省自然科学基金资助项目(编号:1608085MH210)
关键词
颅内动脉瘤
血管内栓塞
术中破裂
危险因素
Intracranial aneurysm
Endovascular embolization
Intraoperative rupture
Risk factors
