影响aSAH血管内治疗预后的相关因素分析

发布时间：2018-05-18 22:30

  本文选题：蛛网膜下腔出血 + 动脉瘤　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:颅内动脉瘤是因为局部血管异常改变形成的异样突起,约70%的蛛网膜下腔出血由其引起。目前认为脑血栓形成、高血压脑出血和颅内动脉瘤是形成脑血管意外的三大主要原因,颅内动脉瘤位居第3位。动脉瘤性蛛网膜下腔出血(aSAH)如未得到及时、有效的治疗,动脉瘤首次破裂出血会引起约15%-20%的患者死亡;2年内的死亡率高达75%-85%;aSAH患者有幸存活下来,超过一半可能遗留偏瘫、语音功能障碍等神经损伤。目前对于aSAH患者的治疗主要为血管内治疗和开颅夹闭两种,本次研究的课题是希望在一定程度上降低患者致残率和病死率,提高生存质量,改善预后。本文就影响血管内治疗动脉瘤性蛛网膜下腔出血预后的相关因素进行系统性的回顾分析和总结。方法:本文通过分析影响aSAH预后的相关因素,主要分析包括性别、年龄、有无高血压病史、有无糖尿病病史、有无吸烟饮酒史、责任动脉瘤的部位和大小、改良Fisher分级、入院时Hunt-Hess分级、格拉斯哥生存质量(G0S)、世界神经外科医师联盟(WFNS)分级、有无血管痉挛、有无脑积水、有无再出血、有无脑缺血、有无低钠血症、手术方式等因素,对上述相关因素与患者3月后随访结果或出院时GOS分别进行X2检验和t检验,以小于0.05为差异有统计学意义。结果:患者性别、责任动脉瘤的部位、手术方式等进行X2检验,分析结果显示:上述因素与经血管内治疗aSAH患者预后无相关性(P0.05),对患者年龄、动脉瘤最大直径进行t检验结果显示:动脉瘤最大直径与患者预后无相关性(P=0.699);而患者年龄与经血管内治疗aSAH患者预后相关(P0.05)。患者有无高血压病史、有无糖尿病病史、有无吸烟饮酒史、入院时Hunt-Hess分级、改良Fisher分级、WFNS分级、有无血管痉挛、有无脑积水、有无再出血、有无脑缺血、有无低钠血症等相关因素进行X2检验,结果显示:这些相关因素与经血管内治疗aSAH患者预后的差异有统计学意义(P0.05)。结论:目前对于动脉瘤性蛛网膜下腔出血的病因、病理、发病机理、治疗、预后等进行了大量的实验研究,相关治疗手段不断完善,但其仍然是导致死亡和残疾较常见的一种脑血管疾病,其"起病急骤,病情凶险,预后差"的特点决定了 aSAH必将引起神经科医师的足够重视。因此,如何能有效的干预aSAH的进展,如何有效的提高患者生存质量,改善预后,是临床医生必须面对的一个严峻考验,具有重要的现实意义。这就需要我们加强术前评估,选择好的手术时机和方式,术后的护理和监测,尽量避免手术并发症。本研究就患者性别、年龄、有无高血压病史、有无糖尿病病史、有无吸烟饮酒史、入院时Hunt-Hess分级、责任动脉瘤的部位和大小、改良Fisher分级、WFNS分级、有无血管痉挛、有无脑积水、有无再出血、有无脑缺血、有无低钠血症、手术方式、3月后随访结果或出院时GOS等结果进行研究和分析,希望本次的研究结果对临床工作(患者的监护、管理、治疗)提供一定的帮助,因此分析研究影响血管内治疗aSAH预后的相关因素具有一定的实用价值。
[Abstract]:Objective: intracranial aneurysms are caused by abnormal changes in local vascular changes. About 70% of the subarachnoid hemorrhage is caused by it. It is considered that cerebral thrombosis, hypertensive intracerebral hemorrhage and intracranial aneurysm are the three major causes of cerebral vascular accident. Intracranial aneurysms are the third. Aneurysmal subarachnoid hemorrhage (aSAH) Without timely and effective treatment, the first ruptured aneurysm of aneurysm will cause death of about 15%-20% patients; the death rate is up to 75%-85% within 2 years; aSAH patients have the privilege of surviving, more than half of them may remain hemiplegia, phonological dysfunction, and other nerve injuries. Current treatment for aSAH patients is mainly intravascular therapy and craniotomy. The subject of this study is to reduce the rate of disability and mortality, improve the quality of life and improve the prognosis to a certain extent. This paper systematically reviewed and analyzed the related factors affecting the prognosis of intravascular aneurysmal subarachnoid hemorrhage. Methods: the relevant factors affecting the prognosis of aSAH were analyzed in this paper. The main analysis included sex, age, history of hypertension, history of diabetes, the history of smoking and drinking, the location and size of the responsible aneurysm, improved Fisher classification, Hunt-Hess classification at admission, Glasgow quality of life (G0S), the world neurosurgeon Union (WFNS) classification, vasospasm, hydrocephalus, or no rebleeding There were some factors such as whether cerebral ischemia, hyponatremia, operation mode and other factors. X2 test and t test were performed on the above related factors and patients' follow-up results after March or at discharge. The difference was statistically significant with the difference of less than 0.05. Results: the sex, the location of the responsible aneurysm, the mode of operation, and so on were examined by X2 test. The results showed that the above results showed that the aforementioned causes were 0.05 There was no correlation between the prognosis and the prognosis of aSAH patients treated with intravascular treatment (P0.05). The t test of the maximum diameter of the aneurysm showed that the maximum diameter of the aneurysm was not related to the prognosis of the patients (P=0.699), and the patient's age was associated with the prognosis of the patients with aSAH (P0.05). There were no smoking and drinking history, Hunt-Hess classification at admission, improved Fisher classification, WFNS classification, no vasospasm, no cerebral hydrocephalus, no rebleeding, cerebral ischemia, or hyponatremia, and other related factors of X2 test. The results showed that the correlation factors and the prognosis of aSAH patients with intravascular treatment were statistically significant (P0.05). The etiology, pathology, pathogenesis, treatment and prognosis of aneurysmal subarachnoid hemorrhage have been studied in a large number of experiments, and the related treatment methods are constantly improved, but it is still a common cerebrovascular disease causing death and disability. The characteristics of "urgent sudden onset, dangerous condition, poor prognosis" determine that aSAH will certainly be cited. The neurologist pays much attention to it. Therefore, how to effectively intervene the progress of aSAH, how to effectively improve the quality of life and improve the prognosis is a severe test that the clinician must face, which is of great practical significance. Monitoring, as far as possible to avoid surgical complications. In this study, the patient's sex, age, history of hypertension, history of diabetes, smoking and drinking history, Hunt-Hess classification at admission, location and size of responsible aneurysm, improved Fisher classification, WFNS classification, vasospasm, hydrocephalus, no rebleeding, cerebral ischemia, or low The results of sodium hypernatremia, surgical procedure, follow-up results after March or GOS at discharge were studied and analyzed. It is hoped that the results of this study will provide some help to the clinical work (patient's monitoring, management and treatment). Therefore, it is of practical value to analyze and study the related factors that affect the prognosis of aSAH in blood vessels.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743
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本文编号：1907500