栓塞治疗颅内破裂动脉瘤并发术中再破裂事件的危险因素分析

发布时间：2018-04-04 22:02

  本文选题：颅内动瘤　切入点：栓塞　出处：《安徽医科大学》2017年硕士论文

【摘要】：目的探讨血管内治疗颅内破裂动脉瘤并发术中再破裂的危险因素及对血管内治疗颅内破裂动脉瘤并发术中再破裂事件发生的防治。方法回顾性分析2010年1月至2015年12月我科收治的678例共678枚动脉瘤经血管内栓塞治疗的颅内破裂动脉瘤患者临床资料,采集的数据包括:性别、年龄、高血压史、糖尿病、颅内动脉粥样硬化史、Hunt-Hess分级、动脉瘤的大小、部位、瘤颈特征、血管痉挛情况、治疗时间、治疗方案、手术并发症(术中动脉瘤破裂)等。对以上数据采用单因素结合多因素非条件Logistic回归分析方法,分析手术并发症的危险因素。所有统计资料用SPSSl7.0统计分析系统进行分析,当P0.05时差异有统计学意义。探索血管内栓塞治疗的颅内破裂动脉瘤患者事件的相关危险因素,并对其中20例发生术中再破裂病例的处理方法进行经验总结。结果共行栓塞治疗678例病人伴678枚破裂动脉瘤,男性318例(47%)、女性360例(53%),平均发病年龄为56.2+8.6岁。入院时Hunt-Hess分级:Ⅰ-Ⅲ级608例(90%),Ⅳ-Ⅴ级70例(10%)。其中位于前循环595枚(87.8%)、后循环83枚(12.2%),微小型动脉瘤97例(14.3%)、小型动脉瘤520例(76.7%)、大型或者巨大型动脉瘤61例(8.9%),宽颈动脉瘤共212例(31.2%)、窄颈动脉瘤466例(68.8%)。颅内破裂动脉瘤栓塞术中再破裂20例,发病率为2.94%,死亡率25%。12例颅内破裂动脉瘤患者由于行硫酸鱼精蛋白中和肝素结合颅内动脉瘤快速栓塞而存活,3例患者因行急诊脑室外引流术存活,但是其中有8例患者身体有不同程度伤残以及7例痊愈。可能引起术中再破裂事件的危险因素有:微小动脉瘤(χ2=11.372,P0.05)、术中出现血管痉挛(χ2=6.119,P0.05)、动脉粥样硬化(χ2=4.673,P0.05);而性别、年龄、高血压病史、糖尿病病史、Hunt-Hess分级、瘤颈特征、治疗方案及治疗时间与术中发生动脉瘤破裂事件无明显关系(p0.05)。结论动脉粥样硬化、血管痉挛及微小动脉瘤是血管内治疗颅内破裂动脉瘤并发术中再破裂的危险因素,硫酸鱼精蛋白中和肝素结合颅内动脉瘤快速栓塞被证实是最有效的抢救措施。
[Abstract]:Objective to investigate the risk factors of intraoperative rerupture of intracranial ruptured aneurysms and the prevention and treatment of intraoperative rerupture of intracranial ruptured aneurysms.Methods the clinical data of 678 patients with ruptured intracranial aneurysms treated by endovascular embolization from January 2010 to December 2015 were retrospectively analyzed. The data included gender, age, history of hypertension, diabetes mellitus.The history of intracranial atherosclerosis included Hunt-Hess grade, size, location, neck characteristics, vasospasm, treatment time, treatment plan, operative complications (rupture of aneurysm during operation) and so on.Univariate and multivariate non-conditional Logistic regression analysis was used to analyze the risk factors of surgical complications.All statistical data were analyzed by SPSSl7.0 statistical analysis system, when P0.05, the difference was statistically significant.To explore the risk factors of intracranial ruptured aneurysms treated by endovascular embolization, and to summarize the experience of 20 cases of intraoperative rerupture.Results A total of 678 ruptured aneurysms were treated with embolization in 678 patients (318 males and 360 females) with an average age of 56.2 years.On admission, the Hunt-Hess grade was 608 cases of grade 鈪，

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