影响大脑中动脉瘤患者手术预后的多因素分析

发布时间：2018-03-25 01:07

本文选题：大脑中动脉瘤　切入点：手术预后　出处：《青岛大学》2017年硕士论文

【摘要】：目的:探讨影响大脑中动脉瘤手术预后的多种因素,为提高大脑中动脉瘤疗效提供理论参考。方法:回顾性分析青岛大学附属医院自1996-2015年开颅手术治疗的260例大脑中动脉瘤患者,总结临床资料和预后情况。预后的评定指标以GOS评分为依据,选取可能存在影响手术疗效相关的13项因素,分析对其预后的影响。把13项观察指标性别,年龄,蛛网膜下腔出血次数,Hunt-Hess分级,术前神志,动脉瘤的侧别,动脉瘤的大小,动脉瘤的发出部位,动脉瘤的指向,手术时机,术中有无破裂,CT示SAH特点,术后并发症作为自变量,定义疗效为因变量,与疗效相关的各项因素定性并赋值。第一步,分析各个单因素与预后的关系,即定性的自变量是否对预后的结果有影响,本文采用非参数统计多样本秩和检验探究定性自变量对预后是否影响,若秩和检验结果P0.05,表明通过检验,即有统计学意义。反之,不通过检验。第二步,建立二元Logistic回归模型,在第一步的基础上选择通过检验的自变量,且将预后的四种情况分为两类,第一级作为第一类,表示预后效果良好,即治愈情况表示预后良好,第二、三、四级作为第二类,表示预后效果较差,即治疗情况认为预后不良,在此基础上做二元Logistic回归模型。运用统计学软件SPSS17.0进行二元Logistic回归分析计算检验,分析并寻找对手术预后有明显统计学意义的因素。结果:统计学单因素分析显示患者的蛛网膜下腔出血的次数、Hunt-Hess分级、术前的神志情况、CT示SAH特点、术后并发症具有对手术治疗预后影响差异,具有显著的统计学意义,是影响预后的危险因素。再用二元Logistic逐步回归法筛选变量,结果表明Hunt-Hess分级、术后并发症是影响大脑中动脉瘤患者预后的显著危险性因素,即影响效果显著。性别,年龄,动脉瘤的侧别,动脉瘤的大小,动脉瘤的发出部位,动脉瘤的指向,手术时机,术中有无破裂等因素与行大脑中动脉瘤夹闭术的患者疗效并无统计学关系。结论:大脑中动脉瘤患者术后是否出现相关并发症与Hunt-Hess分级是影响手术预后的显著危险因素,通过对患者术后是否出现相关并发症、蛛网膜下腔出血的次数、Hunt-Hess分级、术前的神志情况、CT示SAH特点等大脑中动脉瘤的危险性因素的全面系统的分析,可以基本评估大脑中动脉瘤的预后情况,提高预测预后的准确性,寻找改善预后的突破点,进而下一步避免和控制危险性因素,改善治疗手段并采取措施,为后续更好的治疗提供参考,以改善临床预后。
[Abstract]:Objective: to investigate the factors influencing the prognosis of middle cerebral aneurysm. Methods: 260 cases of middle cerebral aneurysm treated by craniotomy in Qingdao University from 1996 to 2015 were analyzed retrospectively. The clinical data and prognosis were summarized. The prognostic evaluation indexes were based on the GOS score, and 13 factors related to the outcome of the operation were selected, and the influence on the prognosis was analyzed. The number of subarachnoid hemorrhage was Hunt-Hess grade, preoperative consciousness, the side of aneurysm, the size of aneurysm, the location of aneurysm, the direction of aneurysm, the timing of operation, the CT features of intraoperative rupture or not, and postoperative complications as independent variables. The first step is to analyze the relationship between each single factor and the prognosis, that is, whether the qualitative independent variable has an effect on the outcome of the prognosis. In this paper, the non-parametric statistical multi-sample rank sum test is used to investigate whether qualitative independent variables affect the prognosis. If the result of rank sum test is P0.05, it shows that there is statistical significance through the test. Conversely, the non-pass test is not passed. In the second step, a binary Logistic regression model is established. On the basis of the first step, the independent variables that have passed the test are selected, and the four conditions of prognosis are divided into two categories. The first stage, as the first category, indicates that the prognosis is good, that is, the cure condition indicates a good prognosis, and the second, third, and fourth levels are the second category. The results show that the prognosis is poor, that is, the treatment considers the prognosis to be poor, on the basis of which the binary Logistic regression model is made. The statistical software SPSS17.0 is used to calculate and test the binary Logistic regression analysis. Results: single factor analysis showed the frequency of subarachnoid hemorrhage in patients and the Hunt-Hess grade. The preoperative mental state and CT showed SAH features. Postoperative complications have significant difference in the prognosis of surgical treatment, and are significant risk factors for prognosis. Binary Logistic stepwise regression method was used to screen the variables, the results showed that the Hunt-Hess grade. Postoperative complications are significant risk factors affecting the prognosis of patients with middle cerebral artery aneurysms, i.e., the effects are significant: sex, age, the side of the aneurysm, the size of the aneurysm, the location of the aneurysm, the location of the aneurysm, the direction of the aneurysm, the timing of the operation. There was no significant correlation between the outcome of middle cerebral aneurysm clipping and whether there were related complications or not in patients with middle cerebral artery aneurysm. Conclusion: Hunt-Hess grade and postoperative complications are significant risk factors for prognosis of patients with middle cerebral artery aneurysm. The risk factors of middle cerebral aneurysm, such as the complications, the frequency of subarachnoid hemorrhage, the Hunt-Hess grade, the preoperative mental state and the characteristics of SAH, were analyzed systematically. It can evaluate the prognosis of middle cerebral aneurysm, improve the accuracy of predicting prognosis, find a breakthrough point to improve the prognosis, and then avoid and control the risk factors, improve the treatment methods and take measures. To provide a reference for further better treatment to improve the clinical prognosis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.12

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