Objective To investigate the risk factors of endovascular embolization in the treatment of elderly patients with ruptured intracranial aneurysms in subarachnoid hemorrhage. Method A retrospective analysis of the clinical data of 75 patients in Zhuzhou Hospital of Xiangya Medical College with bleeding of ruptured intracranial aneurysms in subarachnoid hemorrhage from March 2013 to December 2015. According to the modified Rankin score (mRS) patients were divided into good prognosis group (0 ~ 2 score, n = 63) and poor prognosis group (3 ~ 6 score, n = 12). A variety of factors affecting the prognosis of the two groups including age, gender, underlying diseases, World Federation of Neurosurgical Societies (WFNS) grade, Fisher grade, location of the aneurysm, aneurysm diameter, duration of surgery, shunt dependent hydrocephalus and complications were compared and analyzed. Result The proportion of 60 ~ 65 years old, the proportion ofⅠ~Ⅲ level for WFNS grade, the proportionof 1 ~ 2 level for Fisher grade in good prognosis group were all significantly higher than that of poor prognosis group (60.3% ︰ 25.0%, 90.5% ︰ 50.0%, 79.4% ︰ 16.7%) (P < 0.05); the proportion of patients with shunt dependent hydrocephalus, the proportion of patients with complications in good prognosis group were all significantly lower than those of poor prognosis group (7.9%︰50.0%, 20.6% ︰ 75.0%) (P < 0.05). The risk factors for prognosis in 75 cases with ruptured intracranial aneurysms in subarachnoid hemorrhage treated with endovascular embolization were Fisher grade (OR=2.395, P = 0.035) and shunt dependent hydrocephalus (OR = 2.475, P = 0.024). The 3 ~ 4 level for Fisher grade and shunt dependent hydrocephalus after treatment meaned poor prognosis. Conclusion For the patients with massive hemorrhage and the presence of shunt dependent hydrocephalus after endovascular embolization, measures should be taken as soon as possible to reduce the morbidity and mortality.%目的 探讨血管内栓塞治疗老年颅内动脉瘤破裂性蛛网膜下腔出血患者预后危险因素.方法 回顾性分析2013年3月至2015年12月中南大学湘雅医学院附属株洲医院收治的75例颅内动脉瘤破裂性蛛网膜下腔出血患者的临床资料,根据改良Rankin评分量表得分将患者分为预后良好组(0~2分,63例)和预后不良组(Rankin评分3~6分,12例).分析可能影响两组患者预后的因素,包括年龄、性别、基础疾病、世界神经外科医师联盟(World Federation of Neurosurgical Societies,WFNS)分级、Fisher分级、动脉瘤位置、动脉瘤直径、手术时间、分流依赖性脑积水及并发症.结果 预后良好组60~65岁患者占比、WFNS分级Ⅰ~Ⅲ级患者占比、Fisher分级1~2级患者占比均明显高于预后不良组(60.3%︰25.0%,90.5%︰50.0%,79.4%︰16.7%)(P<0.05);有分流依赖性脑积水患者占比、有并发症患者占比均明显低于预后不良组(7.9%︰50.0%,20.6%︰75.0%)(P<0.05).75例患者经血管内栓塞治疗预后危险因素包括:Fisher分级(OR=2.395,P=0.035),分流依赖性脑积水(OR=2.475,P=0.024).Fisher分级3~4级患者及有分流依赖性脑积水的患者经血管内栓塞治疗后预后较差.结论 临床上对于血管内栓塞治疗后出血量较多及存在分流依赖性脑积水的患者,应尽早采取措施,降低致残及致死率.
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