颅内前交通动脉动脉瘤传统手术治疗的临床预后相关因素回顾性分析

发布时间：2018-02-28 04:36

本文关键词： 颅内动脉瘤蛛网膜下腔出血动脉瘤夹闭回顾性分析　出处：《昆明医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：颅内动脉瘤(intracranial aneurysm)系颅内动脉血管由于一系列因素作用所致血管壁的异常突起。动脉瘤好发年龄一般为40-60岁,女性略高于男性,是目前脑血管疾病中致死、致残率最高的疾病；其中前交通动脉瘤(ACoAA)发病率最高约30%；故临床工作中做到对动脉瘤的早期诊断、早期处理变得至关重要。目的：评估传统开颅手术治疗颅内动脉瘤的疗效、并发症及影响预后的相关因素进行评估、分析。方法：收集42例于2012年9月至2015年1月在云南省第一人民医院神经外科根据影像学资料以“前交通动脉瘤”收治住院的颅内动脉瘤患者,且行传统开颅动脉瘤夹闭术的患者的治疗过程资料作回顾性分析。通过改良Rankin量表评分、本院影像学资料复查情况、有无动脉瘤再出血情况、术后并发症.发病年龄等来评估开颅手术夹闭颅内动脉瘤的治疗效果,并对统计数据进行spss软件x2检验分析。结果：所有42例患者出院时,运用改良Rankin量表来进行预后比较,预后良好评分0-2分,预后不良评分3-5分或死亡。运用统计学分析提示入院时Hunt- Hess分级对预后的影响P值0.05(P=0.017)、术前动脉瘤有无破裂对预后的影响P值0.05(P=0.048),术中动脉瘤有无破裂对预后的影响P值0.05(P=0.039),术后并发脑血管痉挛及术后并发症对患者预后的影响P值0.05(P=0.025),年龄对患者术后预后的影响P值0.05(P=0.801)。结论：临床工作中动脉瘤患者早期手术的总体预后趋势较晚期手术好；对早期手术组的动脉瘤患者在进行亚分组分析得出在发生SAH后24～48小时内进行手术的患者预后较24小时内的患者和48-72小时内的患者总体预后好；动脉瘤患者在发生SAH入院后在血管痉挛期(6-10天)内进行手术的患者总体预后效果较早期手术和晚期手术差;入院时未破裂动脉瘤患者较动脉瘤破裂的患者总体手术效果和预后效果好；术中动脉瘤未破裂的患者较术中动脉瘤破裂的患者总体预后好；术后无严重并发症的患者较有严重并发症的患者总体预后好,年龄60岁者与年龄60岁者术后总体预后无统计学差异。
[Abstract]:Intracranial aneurysm is the abnormal protuberance of the wall of intracranial artery caused by a series of factors. The common age of aneurysm is 40-60 years old, the female is slightly higher than the male, which is the disease with the highest rate of disability and death among cerebrovascular diseases. ACoAAA has the highest incidence of ACoAAs, so it is very important to make early diagnosis and early management of aneurysms in clinical work. Objective: to evaluate the curative effect of traditional craniotomy on intracranial aneurysms. Complications and prognostic factors were evaluated. Methods: from September 2012 to January 2015, 42 patients with intracranial aneurysms admitted to the Department of Neurosurgery in the first people's Hospital of Yunnan Province were treated with anterior communicating aneurysm according to the imaging data. The data of the treatment process of the patients undergoing traditional intracranial aneurysm clipping were retrospectively analyzed. By using the modified Rankin scale, the imaging data of our hospital were re-examined, and whether the aneurysm rebleeding was found. Postoperative complications, age of onset, etc., were used to evaluate the therapeutic effect of clipping intracranial aneurysms after craniotomy, and the statistical data were analyzed by spss software x2. Results: all 42 patients were discharged from hospital, and the prognosis was compared with modified Rankin scale. Prognostic score 0-2, Statistical analysis was used to indicate the influence of Hunt- Hess grading on prognosis on admission (P = 0.05) and the influence of preoperative rupture of aneurysm on prognosis (P = 0.05) and the effect of aneurysm rupture during operation on prognosis. P value was 0.05%, P value was 0.05%, P value was 0.05%, P value was 0.05%, P value was 0.05%, P value was 0.05%, P value was 0.05%, P value was 0.05%, P value was 0.05%, P value was 0.05%. Conclusion: the general prognosis of patients with aneurysm in clinical work is better than that of late operation. The subgroup analysis of aneurysms in the early operative group showed that the prognosis of the patients who underwent the operation within 24 hours after the onset of SAH was better than that of the patients within 24 hours and 48 to 72 hours after the onset of SAH, and the overall prognosis of the patients was better than that of the patients within the first 24 hours and 48 to 72 hours. The overall prognosis of patients with aneurysm undergoing angiospasm within 6-10 days after the onset of SAH was worse than that of early and late surgery. Patients with unruptured aneurysms at admission had better overall operative effect and prognosis than patients with ruptured aneurysms, patients with unruptured aneurysms had better overall prognosis than patients with ruptured aneurysms during operation. The overall prognosis of patients without severe complications was better than that of patients with severe complications. There was no significant difference in the overall prognosis between 60 years old and 60 years old.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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