颅内动脉瘤手术预后影响因素的分析

摘要

目的 探讨影响颅内动脉瘤手术预后的因素.方法 回顾性分析1999年4月-2010年12月,经北京大学第一医院神经外科开颅手术治疗的135例颅内动脉瘤患者的临床资料,对患者的性别、年龄、合并高血压或糖尿病、动脉瘤多次破裂史、多发性动脉瘤、Hunt-Hess分级、术前动脉瘤破裂出血、手术时机、动脉瘤大小、部位(前循环、后循环)、术中动脉瘤破裂、临时阻断动脉时间、手术时间等可能影响预后的因素进行单因素和多因素Logistic分析.依据格拉斯哥预后评分评价手术预后.结果 ①单因素Logistic回归分析显示,年龄、动脉瘤多次破裂、多发性动脉瘤、动脉瘤大小、Hunt-Hess分级、术中动脉瘤破裂6项因素对手术预后有影响,差异有统计学意义(P<0.05).②多因素Logistic逐步回归分析显示,动脉瘤多次破裂(OR=52.514,95%CI:2.238~1232.454)、多发性动脉瘤(OR=26.038,95%CI:2.770~244.764)、Hunt-Hess分级(OR=3.915,95%CI:1.469~10.434)、动脉瘤大小(OR=1.444,95%CI:1.058~1.970)4项因素是影响动脉瘤手术预后的重要因素(均P<0.05 ).结论 动脉瘤的手术预后受多种因素影响,动脉瘤多次破裂、多发性动脉瘤、Hunt-Hess分级、动脉瘤大小是重要的动脉瘤因素.%Objective To investigate the influencing factors affecting the prognosis of intracranial an-eurysm surgery. Methods The clinical data of 135 patients with intracranial aneurysm treated with crani-otomy in the Department of Neurosurgery, Peking University First Hospital from April 1999 to December 2010 were analyzed retrospectively. The factors that might affect the prognosis, including the sex, age, complicated with hypertension or diabetes, history of repeated rupture, multiple aneurysms, Hunt-Hess grade, preoperative rupture, surgical interval, aneurysm size, location, intraoperative aneurysm rupture, temporary arterial occlusion time, and timing of operation were analyzed using logistic regression analysis. According to the GOS scores, the surgical outcomes were evaluated Results (T)Single factor logistic regression analysis revealed that there were significant differences for the impact on surgical outcomes among the age, repeated rupture, multiple aneurysms, aneurysm size, Hunt-Hess grade, and intraoperative aneurysm rupture ( P <0. 05 ). (2)Multivariate logistic stepwise regression analysis showed that the repeated rupture ( OR = 52. 514, 95% CI: 2. 238 - 1232.454 ), multiple aneurysms ( OR = 26.038, 95% CI: 2. 770 - 244. 764 ), Hunt-Hess grade ( OR = 3. 915, 95% CI: 1. 469 - 10. 434 ), and aneurysm size ( OR = 1. 444, 95% CI: 1. 058 - 1. 970 ) were the important factors affecting the prognosis of aneurysm surgery ( all P<0.05 ). ?The prognoses of repeated rupture and multiple aneurysms were poor. The higher the Hunt-Hess grade, the worse the prognosis. The rate of poor surgical prognosis of the aneurysm diameter ^ 10 mm was significantly higher than that of diameter < 10 mm. Conclusion The prognosis of aneurysm surgery is affected by a number of factors. The repeated rupture, multiple aneurysms, Hunt-Hess grade and aneurysm size are the important factors.