摘要
目的
探讨破裂大脑中动脉动脉瘤（middle cerebral artery aneurysm, MCAA）显微外科手术治疗后临床转归不良的危险因素。
方法
回顾性纳入接受显微外科手术治疗的破裂MCAA患者，收集人口统计学资料、既往史、Hunt-Hess分级、格拉斯哥昏迷量表（Glasgow Coma Scale, GCS）评分、影像学特征、手术相关因素以及术后并发症等资料，应用格拉斯哥转归量表（Glasgow Outcome Scale, GOS）进行转归评估，4～5分定义为转归良好，1～3分定义为转归不良。
结果
共纳入44例破裂MCAA患者，其中男性18例（40.9%），女性26例（59.1%），年龄36～75岁，平均58.5岁。动脉瘤夹闭42例（95.5%），包裹2例（4.5%）。术后随访3～36个月，33例（75.0%）转归良好，11例（25.0%）转归不良。单变量分析显示，转归良好组Hunt-Hess分级、中线移位程度、血肿体积、术中破裂、去骨瓣减压以及术后并发肺部感染的患者比例与转归不良组差异有统计学意义。多变量logistic回归分析显示，Hunt-Hess分级Ⅳ～Ⅴ级[优势比（odds ratio, OR）20.885，95%可信区间（confidence interval, CI）1.342～38.696；P＝0.001]、术中动脉瘤破裂（OR 18.906，95% CI 2.918～20.915；P＝0.011）和合并肺部感染（OR 38.865，95% CI 18.718～40.509；P＝0.001）是转归不良的独立危险因素。
结论
Hunt-Hess分级高、术中动脉瘤破裂和术后并发肺部感染是破裂MCAA患者显微外科手术治疗后转归不良的独立危险因素。
Objective
To investigate the risk factors for clinical poor outcome after microsurgical treatment of ruptured middle cerebral artery aneurysms （MCAA）.
Methods
The patients with ruptured MCAA treated with microsurgery were enrolled retrospectively. The data of demography, medical history, Hunt-Hess grade, imaging characteristics, surgery-related factors, and postoperative complications were collected. Glasgow Outcome Scale （GOS） was used to assess the outcomes. GOS 4-5 was defined as a good outcome and 1-3 was defined as a poor outcome.
Results
A total of 44 patients with ruptured MCAA were enrolled, including 26 （59.1%） females and 18 （40.9%） males, aged 36-75 years old （mean 58.5 years）. The aneurysms were clipped in 42 cases （95.5%） and wrapped in 2 cases （4.5%）. They were followed up for 3-6 months, 33 （75.0%） had good outcome and 11 （25.0%） had poor outcome. Univariate analysis showed that there were significant differences in the proportions of Hunt-Hess grade, midline shift degree, hematoma volume, intraoperative rupture, decompressive craniectomy, and postoperative pulmonary infection between the good outcome group and the poor outcome group. Multivariate logistic regression analysis showed that Hunt-Hess grade Ⅳ-Ⅴ （odds ratio [OR] 20.885, 95% confidence interval [CI] 1.342-38.696; P=0.001）, intraoperative aneurysm rupture （OR 18.906, 95% CI 2.918-20.915; P=0.011）, and complicated with pulmonary infection （OR 38.865, 95% CI 18.718-40.509; P=0.001） were the independent risk factors for poor outcomes.
Conclusion
The high Hunt-Hess grade, intraoperative aneurysm rupture, and complicated with pulmonary infection after surgery are the independent risk factors for poor outcomes after microsurgical treatment in patients with ruptured MCAA.
作者
齐文涛
彭爱军
曹德茂
王友伟
武永康
Qi Wentao;Peng Aijun;Cao Demao;Wang Youwei;Wu Yongkang(Department of Neurosurgery, the Affiliated Hospital of Yangzhou University, Yangzhou 225001, China)
出处
《国际脑血管病杂志》
2017年第11期1023-1030,共8页
International Journal of Cerebrovascular Diseases
关键词
颅内动脉瘤
动脉瘤
破裂
大脑中动脉
蛛网膜下腔出血
血肿
神经外科手术
治疗结果
Intracranial Aneurysm
Aneurysm, Ruptured
Middle Cerebral Artery
Subarachnoid Hemorrhage
Hematoma
Neurosurgical Procedures
Treatment Outcome
