颅内动脉瘤显微夹闭手术124例疗效分析及影响预后的危险因素

目的 探讨颅内动脉瘤显微夹闭术的临床疗效及影响预后的危险因素.方法 黄冈市中心医院2014年1月至2016年1月收治的行颅内动脉瘤显微夹闭手术患者124例,其中按Hunt-Hess分级将患者进行分级,Ⅰ级37例,Ⅱ级42例,Ⅲ级28例,Ⅳ级17例.观察患者手术中及手术后出现的并发症情况,分析并发症与预后的关系及影响预后的相关因素.结果 ①124例中,颅内动脉瘤成功夹闭119个,动脉瘤夹闭成功率为95.97%,治愈70例,治愈率为56.45%;②41例患者发生并发症,以脑血管痉挛和动脉瘤破裂为主,未发生并发症患者的预后良好率为95.18%,显著优于发生并发症的患者预后良好率48.78%,差异有统计学意义(χ2=36.707,P<0.05);③Pearson相关分析显示,患者的预后与年龄、基础病史、动脉瘤的大小、术前Hunt-Hess分级、是否发生并发症呈正相关(P<0.05);④多因素logistic回归分析结果显示,年龄、动脉瘤大小、术前Hunt-Hess分级、发生并发症为影响预后的独立危险因素.结论 显微夹闭术是治疗颅内动脉瘤的有效手段,但是其容易发生各种并发症并影响患者的良好预后.患者的年龄、动脉瘤大小、术前Hunt-Hess分级及是否发生并发症均为影响预后的危险因素,因此在对颅内动脉瘤患者进行显微夹闭术时应对影响患者预后的危险因素进行有效的控制.

Clinical effect and the risk factors of prognosis in 124 cases of microsurgical clipping of intracranial aneurysm

Objective To investigate the clinical effect and the risk factors of prognosis in patients with microsurgical clipping of in -tracranial aneurysm.Methods One hundred and twenty-four patients undergoing microsurgical clipping of intracranial aneurysm in Huanggang Central Hospital from January 2014 to January 2016 were selected as study subjects.Among them,37 cases were Hunt-Hess grade Ⅰ,42 cases were grade Ⅱ,28 cases were grade Ⅲ and 17 cases were grade IV.The relationship between complications and prog -nosis and the influence factors were analyzed .Results ① In 124 cases,119 intracranial aneurysms were successfully clipped ;the suc-cess rate of aneurysm clipping was 95.97%,and 70 cases were cured,and the cure rate was 56.45%.② Complications occurred in 41 patients,which were mainly cerebral vasospasm and aneurysm rupture .The good prognosis rate of patients without complications was 95.18%,which was significantly better than that of patients with complications (48.78%);the difference was statistically significant (χ2 =36.707,P <0.05).③ Pearson correlation analysis showed that the prognosis of patients was positively correlated with age ,histo-ry of basic diseases,size of aneurysms,preoperative Hunt-Hess classification and complications (P <0.05).④ The results of multiple factor logistic regression analysis showed that age , aneurysm size , preoperative Hunt -Hess classification , and complications were independent risk factors for prognosis .Conclusions Microsurgical clipping is an effective method for the treatment of intracranial an -eurysms,but it is likely to have various complications and affect the patient 's good prognosis.Age,size of aneurysm,preoperative Hunt-Hess classification and complications are all risk factors of prognosis .Therefore,we should effectively control the risk factors of prognosis in patients with intracranial aneurysms undergoing microsurgical clipping .