影响颅内前循环动脉瘤夹闭术预后的相关因素分析

发布时间：2018-03-16 02:04

本文选题：前循环动脉瘤　切入点：显微外科　出处：《郑州大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的通过对影响颅内前循环动脉瘤夹闭术后疗效的多种相关因素进行综合和分析,发现具有统计学意义的指标,以期对前循环动脉瘤夹闭术起指导作用,最终帮助患者获得最好的手术疗效。方法回顾性总结郑州大学第一附属医院神经外科自2012年01月01日至2013年12月31日接受显微动脉瘤夹闭术的资料完整的98例颅内前循环动脉瘤患者的临床资料。随访时间为患者出院后6—12个月,按照患者的性别分布情况、年龄差异、是否具有高血压史、吸烟史、患者的Fisher和Hunt-Hess分级情况、患者的动脉瘤数量情况、具体位置、具体大小以及手术情况(手术时机、术中动脉瘤破裂、术中临时阻断)等相关因素进行分组,并比较各组患者的格拉斯哥预后量表(Glasgow Outcome Scale,GOS)评分结果。采用统计学方法验证各种因素对于临床预后的影响作用效果。结果单因素分析结果表明:①Hunt-Hess分级不同患者的GOS评分结果差异显著,且均有统计学意义(P0.05);②年龄不同患者的GOS评分结果差异显著,且均有统计学意义(P0.05);③有无高血压病史的患者的GOS评分结果差异不显著,且无统计学意义(P0.05);④有无吸烟史的患者的GOS评分结果差异不显著,且无统计学意义(P0.05);⑤数量、部位和瘤囊最大径不同患者的GOS评分结果差异不显著,且无统计学意义(P0.05);⑥不同手术时机患者的GOS评分结果差异不显著,且无统计学意义(P0.05);⑦术中有无动脉瘤破裂的患者的GOS评分结果差异不显著,且无统计学意义(P0.05);⑧术中是否曾行临时阻断的患者的GOS评分结果差异不显著,且无统计学意义(P0.05);⑨性别不同患者的GOS评分结果差异不显著,且无统计学意义(P0.05);⑩患者的不同Fisher分级与术后疗效(GOS)的关系采用两样本比较的秩和检验。结果显示P0.01,有明显统计学差异。这说明术前头颅CT显示单纯蛛网膜下腔出血(subarachnoid hemorrhage,SAH)的患者比有脑室内出血和/或脑实质内血肿的患者预后明显要好。结论Hunt-Hess分级与Fisher分级情况,这两者是影响患者行动脉瘤夹闭术后疗效的危险因素。而患者的性别、年龄、高血压史、吸烟史、动脉瘤数量、动脉瘤部位、动脉瘤大小、手术时机、术中临时阻断和术中动脉瘤破裂等都不是影响患者预后的危险因素。
[Abstract]:Objective to find out statistically significant indexes by synthesizing and analyzing various related factors that influence the curative effect of anterior circulation aneurysm clipping in order to guide the operation of anterior circulation aneurysm clipping. Methods 98 patients received microaneurysm clipping from January 1st 2012 to December 31st 2013 were reviewed retrospectively in neurosurgery department of the first affiliated hospital of Zhengzhou University. Clinical data of patients with internal anterior circulation aneurysms. According to gender distribution, age difference, history of hypertension, history of smoking, Fisher and Hunt-Hess grading, number of aneurysms, location, size, and operation (timing of operation), Related factors such as rupture of aneurysm during operation and temporary occlusion during operation were divided into groups. The results of Glasgow Outcome scale score were compared. Statistical methods were used to verify the effect of various factors on the clinical prognosis. Results the univariate analysis showed that: 1 Hunt-Hess grade of patients with different grades of patients. There were significant differences in GOS scores, There were significant differences in GOS scores between patients with different ages and with or without history of hypertension, and there was no significant difference in GOS scores between patients with different ages and with or without history of hypertension, and there was no significant difference in GOS scores between patients with different ages and with or without history of hypertension, and there was no significant difference in GOS scores between patients with or without history of hypertension. There was no significant difference in the GOS score between the patients with or without smoking history, and there was no significant difference in the number of P0.05 and the GOS score between the patients with different location and the largest diameter of the tumor sac, and there was no significant difference in the GOS score between the patients with different sites and the largest diameter of the tumor sac. There was no significant difference in GOS score between patients with different operative time and no significant difference in GOS score between patients with or without rupture of aneurysm. There was no significant difference in the GOS score between the patients who had undergone temporary occlusion or not, and there was no significant difference in the GOS score between the patients with different genders and the patients with no significant difference in P0.05 or P0.05, and there was no significant difference in the GOS scores between the two groups, and there was no significant difference in the GOS scores between the two groups. There was no statistical significance in the relationship between Fisher grade and postoperative curative effect in patients with P0.05 or 10. The rank sum test was used to compare the two samples. The results showed that there was a significant difference in P0.01. this indicated that the preoperative cranial CT showed the simple subarachnoid cavity exophthalmos. The prognosis of patients with subarachnoid hemorrhage was significantly better than that with intraventricular hemorrhage and / or intracerebral parenchyma hematoma. Conclusion the Hunt-Hess and Fisher grades are better than those with intraventricular hemorrhage and / or intracerebral parenchyma hematoma. These are the risk factors that influence the outcome of aneurysm clipping. Gender, age, history of hypertension, history of smoking, number of aneurysms, location of aneurysm, size of aneurysm, timing of operation, and the patient's sex, age, history of hypertension, history of smoking, number of aneurysms, size of aneurysm, timing of operation. Temporary occlusion during operation and rupture of aneurysm during operation were not risk factors for prognosis.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.12

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