颅内破裂动脉瘤栓塞术中再破裂的临床研究

发布时间：2018-06-17 23:41

  本文选题：颅内动脉瘤 + 血管内治疗　； 参考：《西南医科大学》2017年硕士论文

【摘要】：目的:探讨颅内破裂动脉瘤栓塞术中再破裂的危险因素、预防处置、术后管理及预后转归,为临床治疗策略及围手术期管理提供参考。方法:收集并整理西南医科大学附属医院神经外科2013年8月至2016年8月收治的经血管内栓塞治疗的颅内破裂动脉瘤病例资料。采用单因素结合多因素logistic回归分析患者一般资料、影像学资料、手术相关资料与动脉瘤术中再破裂的关系,寻找动脉瘤术中再破裂的危险因素,并进一步分析影响患者预后的相关因素。结果:本组共纳入病例215例,其中男性102例(47.4%),女性113例(52.6%),平均年龄55.6±10.0岁。入院Hunt-Hess分级Ⅰ级41例(19.1%),Ⅱ级108例(50.2%),Ⅲ级54例(25.1%),Ⅳ级12例(5.6%)。有高血压病史者106例(49.3%),有吸烟史者52例(24.2%)。入院CT改良Fisher分级Ⅰ级49例(22.8%),Ⅱ级59例(27.4%),Ⅲ级70例(32.6%),Ⅳ级37例(17.2%)。动脉瘤位于脑动脉前循环系统者共190例(88.4%),后循环系统共25例(11.6%)。动脉瘤平均大小5.7±2.6mm。规则囊状动脉瘤136例(63.3%),不规则囊状动脉瘤43例(20.0%),多分叶或带子瘤动脉瘤36例(16.7%)。本组病例早期接受手术者有80例(37.2%),中期接受手术者有88例(40.9%),延期接受手术者有47例(21.9%)。其中接受单纯弹簧圈栓塞者有108例(50.2%),支架辅助弹簧圈栓塞者有95例(44.2%),球囊辅助弹簧圈栓塞者有12例(5.6%)。术后即刻造影结果显示动脉瘤完全栓塞(RS 1级)175例(81.4%),近全栓塞(RS 2级)32例(14.9%),不全栓塞(RS 3级)8例(3.7%)。本组病例中动脉瘤术中破裂16例(7.4%)。单因素显示小型动脉瘤(P=0.004)、多分叶或带子瘤动脉瘤(P=0.033)、中期手术(P=0.019)、术中脑血管痉挛(P=0.016)是动脉瘤术中破裂的危险因素,多因素分析显示小型动脉瘤(OR,4.259;95%CI,1.107-16.393;P=0.035)、多分叶或带子瘤动脉瘤(OR,7.615;95%CI,1.857-31.234;P=0.005)、中期手术(OR,3.613;95%CI,1.106-11.809;P=0.033)以及术中脑血管痉挛(OR,5.731;95%CI,1.448-22.683;P=0.013)是动脉瘤术中破裂的独立危险因素。研究结果显示动脉瘤术中破裂患者术后有更高的症状性脑血管痉挛发生率(P=0.021),但动脉瘤术中破裂不增加患者需手术干预的脑积水的发生率。随访结果显示其总体残死率达37.5%,显著高于未发生术中破裂患者(P=0.002)。结论:颅内破裂动脉瘤栓塞术中再破裂发生率高,残死率高,严重影响患者预后,小型动脉瘤、多分叶或带子瘤动脉瘤、中期手术、术中脑血管痉挛是其发生的独立危险因素,动脉瘤术中破裂患者术后更易发生症状性脑血管痉挛,有效的术前评估、预防、及时准确的处置、术后精细管理等有助于减少此并发症的发生,提高患者预后。
[Abstract]:Objective: to explore the risk factors, prevention and treatment, postoperative management and prognosis of intracranial ruptured aneurysms during embolization, and to provide reference for clinical treatment and perioperative management. Methods: data of intracranial ruptured aneurysms treated by endovascular embolization from August 2013 to August 2016 in Neurosurgery Department affiliated Hospital of Southwest Medical University were collected and analyzed. Univariate and multivariate logistic regression analysis was used to analyze the relationship between the general data, imaging data, surgical data and rerupture during aneurysm operation, and to find out the risk factors of rerupture during aneurysm operation. The factors related to the prognosis of the patients were further analyzed. Results: a total of 215 cases were included in this study, of which 102 cases were male and 113 cases were female, with an average age of 55.6 卤10.0 years. Hunt-Hess grade 鈪，

本文编号：2032983