破裂动脉瘤发生迟发性脑缺血的影响因素分析
发布时间：2018-10-15 14:24
【摘要】：第一部分动脉瘤性蛛网膜下腔出血后迟发性脑缺血影响因素META分析目的目前关于动脉瘤性蛛网膜下腔出血后发生迟发性脑缺血(DCI)的影响因素的报道尚不统一,尤其是关于手术和介入治疗对DCI的不同的影响结果的报道仍有分歧。因此本课题通过Meta分析,探讨动脉瘤性蛛网膜下腔出血后发生迟发性脑缺血的影响因素及其相关危险度,为动脉瘤性蛛网膜下腔出血(aSAH)患者预防DCI提供理论依据。方法搜集PubMed上近10年关于动脉瘤性蛛网膜下腔出血后迟发性脑缺血影响因素相关的文献,利用Revman 5.2软件对纳入文献相关指标畸形META分析,计算每个影响因素的优势比(OR值)及95%置信区间。结果此次研究共纳入13篇相关文献,共5084名患者,其中发生DCI的患者为1338人,DCI总发生率为26.3%。Meta分析结果还提示各因素合并OR值及95%置信区间分别:性别0.87(0.68-1.12)、高血压(Hypertension)病史1.26(0.76-2.09)、吸烟史1.28(0.92-1.77)、入院时临床分级(Clinical Grade)0.35(0.27-0.46)、Fisher分级0.38(0.22-0.65)、治疗方式0.70(0.60-0.81)、动脉瘤位置1.23(0.88-1.71)。结论入院时临床分级、Fisher分级及动脉瘤的治疗方式是影响动脉瘤性蛛网膜下腔出血后发生迟发性脑缺血的影响因素,而性别、高血压病史、吸烟史、动脉瘤位置未显示出有明显相关性。第二部分 破裂动脉瘤术后迟发性脑缺血的影响因素分析(单中心)目的分析本院破裂动脉瘤术后出现迟发性脑缺血的发生率、影响因素和相关临床特点,更深入的研究迟发性脑缺血的影响因素,以期为改善蛛网膜下腔出血患者的预后提供进一步的理论依据。方法回顾性分析我院自2013年1月至2016年6月入院的动脉瘤破裂后蛛网膜下腔出血2周内行手术治疗的患者临床资料,分析迟发性脑缺血的影响因素及发病特点。结果破裂动脉术后迟发性脑缺血发生率为10.7%,经多元回归分析提示治疗方式(开颅夹闭或介入栓塞)(OR=6.645,P0.05)和Fisher分级(OR=5.325,P0.05)是影响破裂动脉瘤患者出现迟发性脑缺血的危险因素。在Fisher分级I-II级的病人中,栓塞组病人和夹闭组病人DCI的发生率均很低,分别为2.4%和4.8%。在Fisher分级III-IV级时栓塞组病人和夹闭组病人DCI发病率分别为3.4%和27.7%,且两者有统计学差异(P0.05)。迟发性脑缺血的部位可以在手术同侧,也可以在手术对侧。DSA造影显示,血管痉挛较严重的一侧,均发生在SAH较重的一侧。结论治疗方式和Fisher分级均是破裂动脉瘤术后DCI的危险因素,即只有在Fisher分级≥3级的患者行夹闭手术时对DCI发生具有高度危险性,而且脑缺血的部位与蛛网膜下腔出血波及的范围相关,且出血较多的部位,发生血管痉挛更为严重。
[Abstract]:Part I factors affecting delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage objective to analyze the factors affecting delayed cerebral ischemia (DCI) after aneurysm subarachnoid hemorrhage (SAH). In particular, reports of the different effects of surgery and interventional therapy on DCI remain controversial. In order to provide a theoretical basis for the prevention of DCI in patients with aneurysm subarachnoid hemorrhage (aSAH), the influencing factors and the related risk of delayed cerebral ischemia after aneurysm subarachnoid hemorrhage (SAH) were investigated by Meta analysis. Methods the literatures about the factors related to delayed cerebral ischemia after aneurysm subarachnoid hemorrhage (SAH) were collected on PubMed in recent 10 years. META analysis was used to analyze the deformity of the related indexes by using Revman 5.2 software. The odds ratio (OR) and 95% confidence interval of each factor were calculated. Results the study included 13 related articles, including 5084 patients. There were 1338 patients with DCI. The total incidence of DCI was analyzed by 26.3%.Meta. The results of 26.3%.Meta analysis also showed that the factors combined with OR and 95% confidence interval were: sex 0.87 (0.68-1.12), history of hypertension (Hypertension) 1.26 (0.76-2.09), smoking history 1.28 (0.92-1.77), clinical (Clinical Grade) 0.35 (0.27-0.46), Fisher) 0.38 (0.22-0.65), treatment side. Type 0.70 (0.60-0.81), aneurysm position 1.23 (0.88-1.71). Conclusion Clinical grade, Fisher grade and treatment of aneurysm on admission are the influencing factors of delayed cerebral ischemia after aneurysm subarachnoid hemorrhage, but gender, history of hypertension, history of smoking, etc. There was no obvious correlation between the location of aneurysm. The second part: analysis of the influencing factors of delayed cerebral ischemia after ruptured aneurysm (single center) objective to analyze the incidence, influencing factors and related clinical characteristics of delayed cerebral ischemia after ruptured aneurysm in our hospital. In order to improve the prognosis of patients with subarachnoid hemorrhage (SAH), the factors affecting delayed cerebral ischemia were further studied in order to provide further theoretical basis for improving the prognosis of patients with subarachnoid hemorrhage. Methods the clinical data of patients with subarachnoid hemorrhage after aneurysm rupture in our hospital from January 2013 to June 2016 were analyzed retrospectively. The influencing factors and characteristics of delayed cerebral ischemia were analyzed. Results the incidence of delayed cerebral ischemia after ruptured artery operation was 10.7. Multiple regression analysis indicated that the treatment methods (craniotomy or interventional embolization) (OR=6.645,P0.05) and Fisher grade (OR=5.325,P0.05) were the risk factors for delayed cerebral ischemia in patients with ruptured aneurysms. The incidence of DCI in embolization group and clipping group was very low (2.4% and 4.8%, respectively) in patients with Fisher grade I-II. The incidence of DCI in embolization group and clipping group was 3.4% and 27.7% respectively when Fisher grade was III-IV grade, and there was statistical difference between them (P0.05). The location of delayed cerebral ischemia can be found on the same side of the operation or on the opposite side of the operation. DSA angiography showed that the side with severe vasospasm occurred in the side with the heavier SAH. Conclusion treatment and Fisher grading are the risk factors of DCI after ruptured aneurysm, that is, only those patients with Fisher grade 鈮，
本文编号：2272829
[Abstract]:Part I factors affecting delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage objective to analyze the factors affecting delayed cerebral ischemia (DCI) after aneurysm subarachnoid hemorrhage (SAH). In particular, reports of the different effects of surgery and interventional therapy on DCI remain controversial. In order to provide a theoretical basis for the prevention of DCI in patients with aneurysm subarachnoid hemorrhage (aSAH), the influencing factors and the related risk of delayed cerebral ischemia after aneurysm subarachnoid hemorrhage (SAH) were investigated by Meta analysis. Methods the literatures about the factors related to delayed cerebral ischemia after aneurysm subarachnoid hemorrhage (SAH) were collected on PubMed in recent 10 years. META analysis was used to analyze the deformity of the related indexes by using Revman 5.2 software. The odds ratio (OR) and 95% confidence interval of each factor were calculated. Results the study included 13 related articles, including 5084 patients. There were 1338 patients with DCI. The total incidence of DCI was analyzed by 26.3%.Meta. The results of 26.3%.Meta analysis also showed that the factors combined with OR and 95% confidence interval were: sex 0.87 (0.68-1.12), history of hypertension (Hypertension) 1.26 (0.76-2.09), smoking history 1.28 (0.92-1.77), clinical (Clinical Grade) 0.35 (0.27-0.46), Fisher) 0.38 (0.22-0.65), treatment side. Type 0.70 (0.60-0.81), aneurysm position 1.23 (0.88-1.71). Conclusion Clinical grade, Fisher grade and treatment of aneurysm on admission are the influencing factors of delayed cerebral ischemia after aneurysm subarachnoid hemorrhage, but gender, history of hypertension, history of smoking, etc. There was no obvious correlation between the location of aneurysm. The second part: analysis of the influencing factors of delayed cerebral ischemia after ruptured aneurysm (single center) objective to analyze the incidence, influencing factors and related clinical characteristics of delayed cerebral ischemia after ruptured aneurysm in our hospital. In order to improve the prognosis of patients with subarachnoid hemorrhage (SAH), the factors affecting delayed cerebral ischemia were further studied in order to provide further theoretical basis for improving the prognosis of patients with subarachnoid hemorrhage. Methods the clinical data of patients with subarachnoid hemorrhage after aneurysm rupture in our hospital from January 2013 to June 2016 were analyzed retrospectively. The influencing factors and characteristics of delayed cerebral ischemia were analyzed. Results the incidence of delayed cerebral ischemia after ruptured artery operation was 10.7. Multiple regression analysis indicated that the treatment methods (craniotomy or interventional embolization) (OR=6.645,P0.05) and Fisher grade (OR=5.325,P0.05) were the risk factors for delayed cerebral ischemia in patients with ruptured aneurysms. The incidence of DCI in embolization group and clipping group was very low (2.4% and 4.8%, respectively) in patients with Fisher grade I-II. The incidence of DCI in embolization group and clipping group was 3.4% and 27.7% respectively when Fisher grade was III-IV grade, and there was statistical difference between them (P0.05). The location of delayed cerebral ischemia can be found on the same side of the operation or on the opposite side of the operation. DSA angiography showed that the side with severe vasospasm occurred in the side with the heavier SAH. Conclusion treatment and Fisher grading are the risk factors of DCI after ruptured aneurysm, that is, only those patients with Fisher grade 鈮，
本文编号：2272829
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