| 杨金亮,罗 靖,张永亮,李 佳,杨铁牛,李式浩,王少华,王晓健.颅内动脉瘤患者介入栓塞手术时机探讨及其预后的影响因素分析[J].,2020,(18):3510-3514 |
| 颅内动脉瘤患者介入栓塞手术时机探讨及其预后的影响因素分析 |
| The Operative Time of Interventional Embolization and the Influencing Factors of Prognosis in Patients with Intracranial Aneurysm |
| 投稿时间：2020-01-09 修订日期：2020-01-31 |
| DOI：10.13241/j.cnki.pmb.2020.18.025 |
| 中文关键词: 介入栓塞术 颅内动脉瘤 手术时机 预后 影响因素 |
| 英文关键词: Interventional embolization Intracranial aneurysm Operative time Prognosis Influence factor |
| 基金项目:安徽省卫生和计划生育委员会科研项目（2017zy0637） |
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| 中文摘要: |
| 摘要 目的：探讨颅内动脉瘤患者介入栓塞的手术时机及其预后的影响因素。方法：纳入安徽医科大学附属阜阳医院和安徽医科大学第一附属医院2015年5月～2017年5月收治的颅内动脉瘤患者130例，均行介入栓塞术治疗。根据手术时机分成早期组（n=78）、延期组（n=52）。早期组在发病?芨3 d行手术，延期组在发病>3 d行手术。比较两组术后动脉栓塞程度、并发症与2年内预后情况。根据预后分成良好组和不良组，采用多因素Logistic回归分析患者预后的影响因素。结果：早期组完全栓塞率为88.46%，高于延期组的73.08%，差异有统计学意义（P＜0.05）。两组动脉瘤出血、肢体障碍、意识障碍、穿刺处感染、脑积水、电解质紊乱发生率比较无显著差异（P＞0.05）。早期组预后良好率为79.49%，显著高于延期组的63.46%（P＜0.05）。不良组术前格拉斯哥预后评分（GOS）≤3分、延迟期手术、瘤体位于后循环、高血压、糖尿病、Hunt-Hess 3～5级、FisherⅢ～Ⅳ级占比显著高于良好组（P＜0.05）。多因素Logistic回归分析结果提示术前GOS评分≤3分、延迟期手术、瘤位置在后循环、高血压、糖尿病、Hunt-Hess3～5级、FisherⅢ～Ⅳ级是患者预后的危险因素（P＜0.05）。结论：颅内动脉瘤患者早期行介入栓塞术，能提高完全栓塞率，改善预后，患者预后不良主要与术前GOS评分、手术时机、瘤位置、高血压、糖尿病、Hunt-Hess分级、Fisher分级有关。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the operative time of interventional embolization and the influencing factors of prognosis in patients with intracranial aneurysm. Methods: 130 patients with intracranial aneurysm who were admitted to Fuyang Hospital Affiliated to Anhui Medical University and the First Affiliated Hospital of Anhui Medical University from May 2015 to may 2017 were selected, they were treated with interventional embolization. The patients were divided into early group (n=78) and delayed group (n=52) according to the operative time. The early group was operated within 3 days after the onset of the disease, and the delayed group was operated after the onset of the disease>3 days. The degree of arterial embolism, complications and prognosis within 2 years were compared between the two groups. According to the prognosis, the patients were divided into the good group and the bad group. Multivariate logistic regression was used to analyze the influencing factors of patients' prognosis. Results: The complete embolism rate of early group was 88.46%, which was higher than 73.08% of delayed group, the difference was statistically significant (P<0.05). There were no significant differences between the two groups in the incidence of aneurysm hemorrhage, limb disorder, consciousness disorder, infection at puncture site, hydrocephalus and electrolyte disorder (P>0.05). The good prognosis rate of early group was 79.49%, which was significantly higher than 63.46% of delayed group (P<0.05). Bad group of preoperative Glasgow outcome scale (GOS)≤3 points, delay surgery, tumors located in the posterior circulation, hypertension, diabetes, Hunt-Hess grade 3~5, Fisher grade Ⅲ~Ⅳ proportion were significantly higher than those of the good group (P<0.05). Multivariate logistic regression analysis showed that GOS score≤3 before operation, delayed operation, tumor location in the posterior circulation, hypertension, diabetes, hunt Hess grade 3-5, Fisher grade Ⅲ-Ⅳ were the influencing factors of poor prognosis (P<0.05). Conclusion: Early interventional embolization can improve the complete embolization rate and prognosis of patients with intracranial aneurysm. The poor prognosis are mainly related to preoperative GOS score, operative time, tumor location, hypertension, diabetes, hunt Hess grade and Fisher grade. |
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