摘要
目的探讨老年颅内动脉瘤患者临时闭塞术中体感诱发电位(SSEP)与围手术期卒中的相关性,以明确SSEP对围手术期卒中的预测价值。方法选择2011年1月—2019年3月在复旦大学附属华山医院静安分院行血管造影辅助下球囊临时阻断下夹闭术的261例老年颅内动脉瘤患者作为研究对象,通过单因素和多因素分析观察SSEP与围手术期卒中相关性。结果261例老年患者术后发生脑卒中25例,发生率9.58%。单因素分析显示,围手术期卒中和无卒中患者性别、年龄、高血压、糖尿病、吸烟、WFNS分级、瘤大小、位置、平均动脉压、SSEP改变潜伏期和临床脑电图爆发抑制等因素差异均无统计学意义(P>0.05),卒中和无卒中患者H-H分级、最长临时闭塞时间、显著SSEP变化、临时闭塞与SSEP重叠时间、多模态SSEP变化等差异均有统计学意义(P<0.05)。二分类多因素Logistic分析结果显示仅显著SSEP变化是影响围手术期脑卒中发生的因素(P<0.05)。结论SSEP显著变化与血管造影辅助下球囊临时阻断下行夹闭术的颅内动脉瘤老年患者围手术期卒中呈相关性,术中发生SSEP显著变化对围手术期卒中具有一定预测价值,值得进一步研究。
Objective To investigate the correlation between the somatosensory evoked potential(SEP)during temporary occlusion and perioperative stroke in the elderly with intracranial aneurysm.Methods 261 elderly with intracranial aneurysms undergoing clamp operation with temporary balloon occlusion assisted by angiography during the period from January,2011 to March,2019 were selected and univariate and multivariate analysis were conducted to analyze the correlation between SEP and perioperative stroke.Results 25 of 261 elderly cases suffered from postoperative stroke and the incidence was 9.58%;there existed no significant differences between the eldery with perioperative stroke and those without in sex,age,histories of hypertension,diabetes and smoking,WFNS grading,tumor size and location,mean arterial pressure,latency of SEP change,and EEG burst suppression(P>0.05)while there existed significant differences in Hunt&Hess grade(HH grade),the duration of the longest temporary occlusion,significant SEP changes,the overlap time between temporary occlusion and SEP,and multimodal SEP changes(P<0.05);multivariate binary logistic regression analysis indicated that obvious SEP change was the influencing factor of perioperative stroke occurrence(P<0.05).Conclusions he obvious SEP change is in independent correlation to perioperative stroke in the elderly with intracranial aneurysm undergoing clamp operation with temporary balloon occlusion assisted by cerebral angiography;it is of certain value in predicating the perioperative stroke occurrence and worthy of further research.
作者
张磊
张晓龙
万军
Zhang Lei;Zhang Xiaolong;Wan Jun(Department of Radiological Intervention,Huashan Hospital Affiliated to Fudan University;Intervention Therapy Department,Jing'an Branch,Huashan Hospital,Shanghai,200040,P.R.China)
出处
《老年医学与保健》
CAS
2019年第5期597-600,共4页
Geriatrics & Health Care
基金
国家自然科学基金(81371308)
关键词
老年
颅内动脉瘤
夹闭术
缺血性脑卒中
血管造影辅助下球囊临时阻断
elderly
intracranial aneurysm
clamp operation
ischemic stroke
temporary balloon occlusion assisted by angiography
