摘要
目的探讨颅内动脉瘤急诊介入治疗术后神经系统并发症的危险因素。方法回顾性分析2014年7月至2018年3月于中国人民解放军联勤保障部队第九二四医院行急诊介入治疗的336例颅内动脉瘤患者的临床资料。记录患者术后1个月内神经系统并发症发生情况,比较不同临床资料患者术后神经系统并发症发生率,采用多因素Logistic回归分析探讨患者术后神经系统并发症的危险因素。结果全部336例患者术后1个月内共有86例出现神经系统并发症,发生率为25.6%,包括术中造影发现急性血栓形成或血管闭塞26例、术后动脉瘤再次破裂出血20例、术后新发脑梗死18例、术中动脉瘤破裂出血14例、术后新发硬膜下出血6例、术后新发脑实质出血2例,其中有9例(2.7%)患者因并发症而死亡。年龄≥65岁、有高血压病史、糖尿病病史、动脉瘤形态不规则、宽颈动脉瘤、动脉瘤囊有小阜、动脉瘤性蛛网膜下腔出血入院患者预后分级为Ⅲ~Ⅴ级、Fisher分级为Ⅲ~Ⅴ级、Hunt-Hess分级为Ⅳ~Ⅴ级的患者术后神经系统并发症发生率均显著升高(均P<0.05)。多因素Logistic回归分析结果表明年龄≥65岁、动脉瘤囊有小阜、Hunt-Hess分级为Ⅳ~Ⅴ级均是颅内动脉瘤患者急诊介入治疗术后神经系统并发症的独立危险因素(均P<0.05)。结论约1/4的颅内动脉瘤患者急诊介入治疗术后出现神经系统并发症。年龄≥65岁、动脉瘤囊有小阜、Hunt-Hess分级Ⅳ~Ⅴ级均为颅内动脉瘤患者急诊介入治疗术后神经系统并发症的独立危险因素。
Objective To investigate the risk factors of neurological complication after emergency interventional therapy for intracranial aneurysm.Method The clinical data of 336 patients with intracranial aneurysm underwent emergency interventional therapy in the 924th Hospital of Joint Logistic Support Force of PLA from July 2014 to March 2018 were retrospectively analyzed.Neurological complication in 1 month after operation were recorded,and the incidence of postoperative neurological complication was compared among patients with different clinical data.Multivariate Logistic regression analysis was used to investigate the independent factors of the postoperative neurological complication.Result 86 patients suffered from neurological complication in 1 month after operation,with a total incidence of 25.6%,including 26 cases of acute thrombus formation or vascular occlusion,20 cases of postoperative aneurysm rupture,18 cases of postoperative new cerebral infarction,14 cases of aneurysm rupture and bleeding during operation,6 cases of postoperative new subdural hemorrhage and 2 cases of postoperative new cerebral hemorrhage.Among them,9 cases(2.7%)died of complications.The incidence of postoperative neurological complication was significantly higher in patients with aged≥65 years old,hypertension history,diabetes mellitus history,irregular shape of aneurysm,wide-necked aneurysm,aneurysm bleb,prognosis on admission of aneurysmal subarachnoid hemorrhage grade Ⅲ~Ⅴ,Fisher grade Ⅲ~Ⅴ and Hunt-Hess grade Ⅳ~Ⅴ(all P<0.05).Results of multivariate Logistic regression analysis showed that age≥65 years old,aneurysm bleb and Hunt-Hess grade Ⅳ~Ⅴ were the independent risk factors of postoperative neurologic complication after emergency interventional therapy for intracranial aneurysm(all P<0.05).Conclusion About 1/4 patients with intracranial aneurysm suffered from neurological complication in 1 month after emergency interventional therapy.Age≥65 years old,aneurysm bleb and Hunt-Hess grade Ⅳ~Ⅴ are the independent r
作者
钱锦涛
孔质彬
林开义
冯子民
何建华
梅强
Qian Jintao;Kong Zhibin;Lin Kaiyi;Feng Zimin;He Jianhua;Mei Qiang(Department of Emergency,the 924th Hospital of Joint Logistic Support Force of PLA,Guangxi,Guilin 541002,China;Department of Cranial and Brain Surgery,the 924th Hospital of Joint Logistic Support Force of PLA,Guangxi,Guilin 541002,China;Department of Neurology,Second People's Hospital of Guilin,Guangxi,Guilin 541001,China;Department of Neurology,the 922nd Hospital of Joint Logistic Support Force of PLA,Hunan,Hengyang 421002,China)
出处
《中国医学前沿杂志（电子版）》
2020年第5期104-108,共5页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
基金
湖南省卫生计生委科研计划项目(C2017022)
桂林市科学研究与技术开发计划课题(20170109-36)。
关键词
颅内动脉瘤
神经系统并发症
介入治疗
危险因素
蛛网膜下腔出血
Intracranial aneurysm
Neurological complication
Interventional therapy
Risk factor
Subarachnoid hemorrhage
