摘要
目的对比分析介入栓塞与手术夹闭治疗颅内动脉瘤术后迟发性脑缺血(DCI)发生特征及危险因素。方法通过对我院2013年1月—2017年6月收治的210例(介入组98例,夹闭组112例)颅内动脉瘤性蛛网膜下腔出血患者临床资料做回顾性分析。比较二组患者DCI发生率、动脉瘤不同位置及数量DCI发生情况、并发症发生及预后情况,采用logistic回归分析颅内动脉瘤术后DCI发生的独立危险因素。结果本组210例患者共有42例(20.00%)患者发生DCI,介入组DCI发生率(10.20%)低于夹闭组(28.57%),二组比较差异有统计学意义(χ~2=11.020,P=0.001);二组患者单发动脉瘤及多发动脉瘤DCI发生率比较差异均无统计学意义(P>0.05);夹闭组的颅内感染率高于介入组(P<0.05),二组患者预后不良率比较差异无统计学意义(P>0.05),本组共有24例(11.42%)患者死亡,其中介入组病死率高于夹闭组(P<0.05);开颅夹闭术(OR=1.983,95%CI:1.369～2.873)、Fisher分级为Ⅲ～Ⅳ级(OR=1.902,95%CI:1.308～2.766)、术后肺部感染(OR=1.754,95%CI:1.126～2.732)、手术时间距动脉瘤破裂≤10d(OR=2.041,95%CI:1.070～3.881)是颅内动脉瘤术后DCI发生的独立危险因素(P<0.05)。结论 DCI是引起颅内动脉瘤术后患者死亡及致残的重要原因,其中开颅夹闭术后的DCI发生率高于介入栓塞术,且行开颅夹闭术、Fisher分级为Ⅲ～Ⅳ级、术后肺部感染、手术时间距动脉瘤破裂≤10d是DCI发生的独立危险因素,应引起重视,改善颅内动脉瘤术后患者预后。
Objective To compare the characteristics of delayed cerebral ischemia after interventional embolization or surgical clipping in the treatment of intracranial aneurysms,and to explore its risk factors.Methods The clinical data of 210 patients with intracranial aneurysmal subarachnoid hemorrhage treated in author′s hospital from January 2013 to June 2017 were retrospectively analyzed.According to the different surgical methods,they were divided into intervention group（98 cases）and clipping group（112 cases）.The incidence of DCI,the location and quantity of DCI,the occurrence and prognosis of two groups of patients were compared.The independent risk factors of DCI after intracranial aneurysm surgery were analyzed by logistic regression model.Results There were 42 cases（20%）of DCI patients in 210 patients,and the rate of DCI in the intervention group（10.20%）was lower than that in the clipping group（28.57%）（χ^2=11.020,P=0.001）.The solitary aneurysm and multiple aneurysms incidence of DCI were no significant difference between the two groups（P〉0.05）.The intracranial infection rate of clipping group was higher than that of the intervention group（P〈0.05）.There were no significant difference between the two groups on bad prognosis rate（P〉0.05）.There were a total of died 24 cases（11.42%）,and the mortality rate of the intervention group was higher than those of clipping group（P〈0.05）;clipping（OR=1.983,95%CI：1.369~2.873）and Fisher grade Ⅲ-Ⅳ（OR=1.902,95%CI：1.308~ 2.766）,postoperative pulmonary infection（OR=1.754,95%CI：1.126~2.732）and the time of aneurysm rupture after operation≤10 d（OR=2.041,95%CI：1.070~3.881）were independent risk factors for DCI after intracranial aneurysm surgery（P〈0.05）.Conclusion DCI is the cause of death in patients after intracranial aneurysm surgery and an important cause of disability,and DCI is higher in the clipping than that in interventional embolization.The line clipping,Fisher grade III-IV,postoperative pul
作者
范高阳
孙彦春
苏春海
刘军
刘运振
张会
冯雷
糜相明
Fan Gaoyang , Sun Yanchun , Su Chunhai , et al.(Department of Neuro-surgery, First People＇s Hospital of Jining, Jining 272011, China)
出处
《中国煤炭工业医学杂志》
2018年第5期512-516,共5页
Chinese Journal of Coal Industry Medicine
基金
济宁市科技发展计划项目(济科字[2016]56号-32)
关键词
介入栓塞
手术夹闭
颅内动脉瘤术
迟发性脑缺血
危险因素
Interventional embolization
Surgical clipping
Intracranial aneurysm
Delayed cerebral ischemia
Risk factors
