影响颅内动脉瘤手术预后的多因素分析(附215例报告)

目的 探讨影响颅内动脉瘤开颅手术预后的因素,以改善动脉瘤的手术治疗效果.方法回顾性分析四川省人民医院神经外科自2002年5月至2007年5月手术治疗的215例颅内动脉瘤患者的临床资料,以疗效作为冈变量,选取可能影响预后的10项指标为自变量.应用多元Logistic回归分析影响颅内动脉瘤手术预后的因素. 结果 本组患者痊愈190例(87.7%),轻中度残疾22例(10.9%),死亡3例(1.4%).统计分析显示年龄、术前Hunt-Hess分级、Fisher分级、动脉瘤位置、术中临时阻断颈内动脉或载瘤动脉、术中动脉瘤破裂与预后有关,而性别、手术时机、术前蛛网膜下腔出血次数和动脉瘤大小对预后无明显影响. 结论 动脉瘤手术预后受多个因素影响,而术中动脉瘤破裂与手术效果之间有更加直接的关系.

Analysis of the factors affecting the prognosis of surgical patients with intracranial aneurysm

Objective To analyze the factors affecting the clinical outcomes of surgical patients with intracranial aneurysm(IA).Methods The clinical data of 215 patients undergoing surgeries for IA between May,2002 and May,2007 were retrospectively analyzed.In all these cases,the diagnoses were established according to the results of CT,CT angiography(CTA)and digital subtraction angiography(DSA).With the therapeutic effect as the dependent variable,logistic regression analysis was performed to examine 10 factors that potentially affected the outcome of the patients.Results In all the patients,190(87.7%)were cured,22(10.9%)had mild to moderate disabilities,and 4(1.4%)died.Statistical analysis showed that age,aneurysm location,temporary occlusion of the parent artery,intraoperative aneurysm rupture,and the preoperative scores of Hunt-Hess scale and Fisher scale were correlated to the prognosis of the patients.Such factors as gender,operative time,and times of preoperative subarachnoid hemorrhage and aneurysm size were not found to obviously affect the patients' prognosis.Conclusions The prognosis of surgical patients with 1A is affected by multiple factors,and intraoperative aneurysm rupture is directly associated with the surgical outcome.