影响破裂颅内动脉瘤患者预后的多因素分析

目的筛选影响破裂颅内动脉瘤预后的相关因素,为颅内动脉瘤的治疗提供理论依据。方法回顾性分析2003年至2007年石家庄市7家医院共794例破裂颅内动脉瘤的病例资料,对794例患者的性别、年龄、临床病情分级、动脉瘤的部位、动脉瘤是否多发、手术时机、手术方式、是否合并高血压以及吸烟等因素进行分析,采用SAS V8统计软件进行资料处理,单因素分析采用χ2检验,然后进行多因素分析,应用Logistic多元回归模型,筛选得到对预后有显著意义的因素。结果单因素分析显示患者的Hunt-Hess病情分级（P〈0.0001）、年龄（P〈0.0001）、是否合并高血压（P=0.0226）这三项临床指标差异有统计学意义;多因素Logistic逐步回归法筛选变量,病情Hunt-Hess分级（P〈0.0001,OR=34.854）、患者年龄（P〈0.0001,OR=1.779）、是否合并高血压（P=0.0057,OR=1.413）等是影响破裂颅内动脉瘤患者预后的独立危险因素。结论破裂颅内动脉瘤患者入院时的Hunt-Hess分级、年龄和是否合并高血压病是影响预后的独立因素;破裂颅内动脉瘤患者入院时Hunt-Hess分级越高、年龄越大以及合并高血压时其临床预后越差。

Multiple factor analysis of prognosis of the patients with ruptured intracranial aneurysms

Objective To investigate the major factors affecting the prognosis of ruptured intracranial aneurysms so as to provide theoretical foundation for the treatment of intracranial aneurysm. Methods The clinical data of 794 cases with ruptured intracranial aneurysms in seven hospitals in Shijiazhuang between 2003 and 2007 were studied retrospectively. Prognostic factors were analyzed according to sex, age, HuntHess classification, location and amount of aneurysms, time and methods of operation, hypertension and smoking. Univariate analysis of variance by X2 test and multivariate analysis by multiple Logistic regression model were carried out to screen risk factors related to the prognosis of ruptured intracranial aneurysms. Results Univariate analysis showed that there was statistical significance of difference in Hunt-Hess grade （ P 〈 0. 0001 ）, age （ P 〈 0. 0001 ） and hypertension （ P = 0. 0226） ; multivariate Logistic regression analysis showed that Hunt-Hess grade （P 〈0.0001, OR =34. 854）, age （P 〈0.0001, OR = 1.779） and hypertension （P =0.0057, OR = 1. 413） were related to the prognosis of ruptured intracranial aneurysms. Conclusion Hunt-Hess grade, age and hypertension are independent risk factors for the prognosis of ruptured intracranial aneurysms. The prognosis of patients with hypertension, more Hunt-Hess scores and aging over 60 is poorer.