颅内动脉瘤术中破裂危险因素分析

目的 分析颅内动脉瘤显微外科手术术中破裂的相关因素.方法 回顾性分析106例开颅显微手术治疗的颅内动脉瘤病人,对可能影响其破裂的因素,如性别、年龄、高血压病史、Hunt-Hess分级、CT-Fisher分级、动脉瘤部位、大小、瘤颈宽窄、手术时机、临时阻断夹应用与否、是否存在假性动脉瘤等,进行单因素和多因素logistic回归分析,寻找影响术中破裂的危险因素.结果 术中破裂动脉瘤的发生率是26.13%;Hunt-Hess分级、动脉瘤瘤颈宽窄、临时阻断与否、是否存在假性动脉瘤是术中动脉瘤破裂的危险因素;宽颈动脉瘤(OR=10.791,P=0.000),存在假性动脉瘤(OR=32.752,P=0.002),Hunt-Hess分级(OR=0.073,P=0.002)是术中动脉瘤破裂独立危险因素;术中临时阻断技术的应用(OR=0.055,P=0.001)是术中动脉瘤破裂独立保护因素.结论 颅内动脉瘤显微外科手术术中破裂主要与宽颈动脉瘤、存在假性动脉瘤、Hunt-Hess分级有关.临时阻断技术的应用为保护因素.

Analysis on risk factors of intraoperative aneurysmal rupture

Objective To analyze and discuss the potential risk factors of intraoperative aneurysmal rupture during microneurosurgery. Methods A retrospective study was performed on 106 consecutive patients with 111 cerebral aneurysms operated upon. Single and multiple factor aaalysis were performed for potential influencing factors, such as age, sex, previous hypertension, Hunt - Hess scale, CT - Fisher scale, location of aneurysm,size of aneurysm, size of aneurysm neck, timing of operation, using or unusing temporary arterial clip, forming or not forming pseudoaneurysm. Results In the 106 patients in this series, 29 aneurysms (26. 13% ) were ruptured in 111 aneurysms during the operation. Single factor analysis revealed that Hunt-Hess scale, size of aneurysm neck, using or not using temporary arterial clip, forming or not forming of pseudoaneurysm were the risk factors of intraoperative aneurysmal rupture. Multiple factor analysis revealed that broader aneurysm neck ( OR = 10. 791, P =0. 000), forming of pseudoaneurysm ( OR =32.752, P = 0. 002), Hunt - Hess scale ( OR = 0. 073, P = 0. 002 ) were the independent risk factors. The use of temporary arterial clip ( OR =0. 055, P =0. 001 ) was an independent protective factor. Conclusion In our analysis, intraoperative aneurysmal rupture may be associated with size of aneurysm neck, forming or not forming pseudoaneurysm, Hunt -Hess scale, and using temporary arterial clip is a protection factor.