摘要
目的研究前交通动脉瘤患者显微手术中不同的手术夹闭方式与预后的相关性。方法回顾性分析2018年1月~2020年12月徐州医科大学附属连云港医院收治的116例前交通动脉瘤患者的临床资料,根据患者出院后3~6个月的格拉斯哥预后评分(Glasgow coma scale,GCS评分)分为两组,即预后良好组(GCS评分为4~5分,n=93)和预后不良组(GCS评分为1~3分,n=23),采用多因素Logistic回归分析评价前交通动脉瘤预后不良的影响因素。结果GCS评分低、Hunt-Hess分级Ⅲ~Ⅳ级、改良Fisher分级Ⅲ~Ⅳ级、术后脑梗死、术后脑血管痉挛、术后脑积水和单线夹闭(动脉瘤夹夹片在一条虚拟线上)与预后不良相关(P<0.05)。多因素Logistic回归分析结果显示,Hunt-Hess分级≥Ⅲ级、术后脑梗死和术后脑积水与预后不良呈正相关(OR值分别为10.899、10.300、2.483、14.360,P<0.05)。多线夹闭(动脉瘤夹夹片在两条及以上虚拟线上)与预后不良呈负相关(OR=0.089,P<0.05)。结论Hunt-Hess分级≥Ⅲ级、术后脑梗死和术后脑积水是前交通动脉瘤显微手术患者预后不良的独立危险因素,多线夹闭是预后良好的一个保护因素。
Objective To study the correlation between different surgical clipping methods and prognosis in patients with anterior communicating artery aneurysms.Methods The clinical data of 116 patients with anterior communicating artery aneurysms treated in the Lianyungang Hospital affiliated to Xuzhou Medical University from January 2018 to December 2020 were analyzed retrospectively.The patients were divided into two groups according to Glasgow coma score(GCS)from 3 to 6months after discharge:good prognosis group(GCS score was 4 to 5,n=93)and poor prognosis group(GCS score was 1 to 3,n=23).Multivariate Logistic regression analysis was used to evaluate the influencing factors of the poor prognosis of anterior communicating artery aneurysms.Results Low GCS score,Hunt-Hess gradeⅢ-Ⅳ,modified Fisher gradeⅢ-Ⅳ,postoperative cerebral infarction,postoperative cerebral vasospasm,postoperative hydrocephalus and single-line clipping(aneurysm sandwiched on a virtual line)were associated with poor prognosis(P<0.05).Multivariate Logistic regression analysis showed that Hunt-Hess grade≥Ⅲ,postoperative cerebral infarction and postoperative hydrocephalus were positively correlated with poor prognosis(OR were 10.899,10.300,2.483,14.360,P<0.05).Multi-line clipping(aneurysm clipping on two or more virtual lines)was negatively correlated with poor prognosis(OR=0.089,P<0.05).Conclusion Hunt-Hess grade≥Ⅲ,postoperative cerebral infarction and postoperative hydrocephalus are independent risk factors for poor prognosis in patients with anterior communicating artery aneurysms.Multi-line clipping was a protective factor for good prognosis.
作者
陈江伟
张乐
刘希光
CHEN Jiangwei;ZHANG Le;LIU Xiguang(Department of Neurosurgery,Lianyungang Hospital Affiliated to Xuzhou Medical University,Jiangsu 222000,China)
出处
《医学研究杂志》
2023年第1期164-167,共4页
Journal of Medical Research
关键词
前交通动脉瘤
显微手术
夹闭方式
预后
Anterior communicating artery aneurysm
Microsurgery
Clipping method
Prognosis
