颅内动静脉畸形患儿血管内栓塞术后出血的危险因素分析

目的探究颅内动静脉畸形(cAVM)行血管栓塞治疗术后出血发生率及相关危险因素。方法选取2013年8月至2018年8月于我院脑外科行血管内栓塞治疗的cAVM患者180例为研究对象,观察其术后1周颅内出血发生情况,比较出血及未出血患者临床资料及畸形血管团特点,采用Logistic回归分析法探究cAVM栓塞术后出血的危险因素。结果cAVM栓塞术后出血发生率为17.78%,多于术后3 d内发生,以脑实质出血最常见。单因素分析显示,高血压史、出血史、畸形血管直径、深静脉引流、合并动脉瘤、栓塞体积、引流静脉栓塞及术后血压未达标与术后出血有关(P<0.05),而性别、年龄、癫痫史、畸形血管位置、S-M分级、栓塞时间及术后使用脱水剂与术后出血无关(P>0.05);多因素分析显示,出血史、深静脉引流及引流静脉栓塞是血管内栓塞术后颅内出血的独立性危险因素(P<0.05)。结论出血史、深静脉引流及引流静脉栓塞是cAVM栓塞术后出血的独立性危险因素,正确认识并在手术过程中采取相应的防范措施有利于降低栓塞出血并发症的发病率。

Risk factors of postoperative bleeding after endovascular embolization in children with intracranial arteriovenous malformation

Objective To investigate the incidence and risk factors of hemorrhage after endovascular embolization in children with intracranial arteriovenous malformation(cAVM).Methods A total of 180 children with cAVM underwent endovascular embolization in our hospital from August 2013 to August 2018 were analyzed.The incidence of intracranial hemorrhage was observed one week after operation.The clinical data and the characteristics of malformed blood vessels in children with and without hemorrhage were compared.Logistic regression analysis was used to explore the risk factors of hemorrhage after cAVM embolization.Results The incidence of bleeding after cAVM embolization was 17.78%,which occurred mostly within 3 days after the operation.Cerebral parenchymal hemorrhage was the most common type.Univariate analysis showed that history of hypertension,history of bleeding,diameter of malformed blood vessels,deep vein drainage,combination of aneurysm,embolization volume,drainage venous embolization,and substandard postoperative blood pressure were related to postoperative bleeding ( P <0.05), while gender,age,history of epilepsy,location of malformed blood vessels,S-M classification,embolization time,and postoperative dehydration were not related to postoperative bleeding ( P >0.05). Multivariate analysis showed that history of bleeding,deep venous drainage,and drainage venous embolization were independent risk factors for intracranial hemorrhage after intravascular embolization ( P <0.05).Conclusion History of bleeding,deep venous drainage and drainage venous embolization are independent risk factors of bleeding after cAVM embolization. Correct recognition and appropriate preventive measures during the operation can be helpful to reduce the incidence of complications.