摘要
目的比较并分析颅内动脉瘤患者夹闭或介入术后迟发性脑缺血(DCI)的发生情况,探讨DCI发生的危险因素。方法收集2011年3月—2014年5月天津医科大学总医院神经外科收治的CT血管造影(CTA)或全脑血管造影(DSA)检查确诊的颅内动脉瘤性蛛网膜下腔出血(a SAH)患者236例,其中135例行开颅夹闭者为夹闭组,101例行介入栓塞者为介入组,比较组间性别、年龄、既往史、术前GCS评分、Hunt-Hess分级、Fisher分级、WFNS分级、动脉瘤位置、预后等,采用二分类Logistic回归分析探讨DCI发生的危险因素。结果夹闭组中36例发生DCI(26.7%),介入组中11例发生DCI(10.9%),夹闭组发生率高于介入组(P<0.01)。对患者进行6个月随访,夹闭组和介入组预后不良率分别为17.0%和25.7%(P>0.01),总体病死率为11.0%,前者病死率低于后者(5.9%vs.17.8%,P<0.01)。Logistic回归结果显示,Fisher分级3~4级、术后肺感染、开颅手术夹闭是DCI发生的独立危险因素(P<0.01)。结论 DCI是导致动脉瘤术后患者致残率和病死率较高的重要因素,介入手术较夹闭手术动脉瘤术后DCI发生率低,密切注意DCI发生的相关危险因素能在一定程度上改善动脉瘤术后患者的预后。
Objective To compare and analyze the occurrence of delayed cerebral ischemia(DCI)after coiling andclipping of intracranial aneurysms,and explore the risk factors of DCI.Methods A total of236patients with aneurysmsdiagnosed by CT angiography(CTA)or digital subtraction angiography(DSA)in Department of Neurosurgery,TianjinMedical University General Hospital were enrolled in this study from March2011to May2014.Patients were divided intoclipping group(n=135)and coiling group(n=101).The clinical characteristics were compared between two groups,includinggender,age,medical history,GCS score,Hunt-Hess grade,Fisher grade,WFNS grade,aneurysm location,prognosis andincidence of DCI.Risk factors for DCI were investigated by Logistic regression analysis.Results DCI was occurred in36patients(26.7%)underwent clipping operation while in11patients(10.9%)underwent coiling operation.The incidence wassignificantly higher in clipping group compared with that of coiling group(P<0.01).The patients were followed up for6months.The poor prognosis rates were17.0%and25.7%in clipping group and coiling group,respectively(P>0.01).Theoverall mortality was11.0%,the former had a lower mortality rate(5.9%vs.17.8%,P<0.01).According to Logisticregression analysis,Fisher Grade3-4,postoperative pulmonary infection and surgical procedure were independent riskfactors for DCI(P<0.01).Conclusion DCI is one of the most significant factors for high fatality and morbidity ofpostoperative aneurysm patients.There is a low occurrence of DCI after coiling compared with that of clipping.If we pay moreattention to risk factors associated with the DCI,it will improve the prognosis of postoperative aneurysm patients greatly.
作者
刘朋然
靳张宁
蔡新旺
张振
高南南
王者
杨新宇
LIU Peng-ran;JIN Zhang-ning;CAI Xin-wang;ZHANG Zhen;GAO Nan-nan;WANG Zhe;YANG Xin-yu(Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China)
出处
《天津医药》
CAS
2017年第2期176-179,共4页
Tianjin Medical Journal
基金
国家自然科学基金资助项目(81571144)
关键词
颅内动脉瘤
脑缺血
危险因素
预后
夹闭
介入
迟发型脑缺血
intracranial aneurysm
brain ischemia
risk factors
prognosis
clip
coil
delayed cerebral ischemia
