颅内动脉瘤显微夹闭手术并发症与预后的关系及影响预后的相关因素

摘要

Objective To explore the correlation between complications and prognosis of microscopic surgical clipping of intracranial aneurysms and tis relevant factors .Methods The 120 patients with intracranial aneurysms who received clipping in our hospital were selected ( 134 intracranial aneurysm), which was divided into level Ⅰwith 35, levelⅡwith 41, levelⅢ34 and level Ⅳ10 according to Hunt-Hess.The complications of intra-and post-operative were observed, and Glasgow outcome scale ( GOS ) scale were used to evaluate the efficacy of patients , then the related influencing factors of the prognosis were analyzed . Results ( 1 ) 32 patients with complications included 12 cases of cerebral vasospasm , 7 cases of aneurysm rupture , 3 cases of cerebral edema , 8 cases of infarction , 5 cases of intracranial infection , and 9 cases of severe pulmonary infection .The higher intracranial aneurysms Hunt-hess grade , the higher the incidence of complications, and difference was statistically significant ( all P <0.05); (2) 132 intracranial aneurysm were successfully clipped (98.5%), 2 cases of aneurysm were wrapped , the cured rate was 62.5%( 75/120 ).The rate of cure and mild disability was higher in patients without complications than in patients with complications , and the rate of severe disability , ADLV and death were lower(all P<0.05).The rate of good prognosis was higher in patients without complications than in patients with complications, but bad prognosis rate was lower [Good prognosis:83(97.6%) vs 20(57.1%); bad prognosis: 2 (2.4%) vs 15 (42.9%), all P <0.05]; (3) Pearson correlation analysis and multiple stepwise regression analysis showed that age , size , Hunt-Hess level ,fracture and complication were the independent related factors influencing prognosis ( P <0.05 -0 .01 ) .Conclusion The success rate of microscopic surgical clipping for intracranial is high .The prognosis is related to age, size, Hunt-Hess level, fracture and complication.%目的：探讨颅内动脉瘤显微夹闭手术并发症与预后的关系及影响预后的危险因素。方法行颅内动脉瘤显微夹闭术患者120例（颅内动脉瘤134个），其中Hunt-Hess分级Ⅰ级35例、Ⅱ级41例、Ⅲ级34例、Ⅳ级10例。观察患者术中、术后出现的并发症，采用格拉斯哥预后量表（ GOS）评分对患者的预后进行判定，分析影响预后的相关因素。结果（1）32例患者出现并发症，其中脑血管痉挛12例、动脉瘤破裂7例、脑水肿3例、脑梗死8例、颅内感染5例及严重肺部感染9例。术前Hunt-Hess分级越高的患者，并发症的发生率越高，差异有统计学意义（均P＜0．05）；（2）手术成功夹闭颅内动脉瘤132个（98．5％），包裹2个，治愈率62．5％（75／120）。未出现并发症者的治愈率、轻度残障率高于出现并发症者，重症残障率、植物生存及病死率低于出现并发症者（均P＜0．05）。未出现并发症者中预后良好率高于出现并发症者，预后差率低于出现并发症者，预后良好：83例（97．6％） vs 20例（57．1％）；预后差：2例（2．4％） vs 15例（42．9％）（均P＜0．05）；（3） Pearson相关分析及多元逐步回归分析显示，年龄、动脉瘤大小、术前Hunt-Hess分级、术中是否发生动脉瘤破裂、是否合并并发症为影响预后的独立相关因素（P＜0．05～0．01）。结论显微夹闭术治疗颅内动脉瘤的夹闭成功率高，预后与年龄、动脉瘤大小、术前Hunt-Hess分级、术中是否发生破裂、是否合并并发症密切相关。