开颅动脉瘤夹闭术患者合并心血管疾病的预后

目的：通过比较实施开颅动脉瘤夹闭术患者合并心血管疾病与否的预后差别，分析其预后影响因素，为临床上改进此类患者围术期管理提供依据。方法：收集2016年5月至2017年2月在中南大学湘雅医院进行开颅动脉瘤夹闭术的患者297例，根据其是否合并心血管疾病分为合并心血管疾病组和非合并心血管疾病组，收集其围术期临床资料、入出院时的神经系统相关功能评估、出院后1年的格拉斯哥预后评分等指标。分析的主要终点指标为出院后1年的格拉斯哥预后评分，次要终点指标为ICU停留时间、出院时神经功能和住院期间不良事件。结果：最终纳入241名患者，两组一般资料中除了年龄因素外均无差别，出院后1年格拉斯哥预后评分差异有统计学意义(P=0.007)，两组的ICU停留时间、出院时神经功能障碍和住院期间不良事件差异也有统计学意义(分别P=0.036，P=0.011，P=0.005)。以主要终点指标出院后1年格拉斯哥预后评分为因变量调整年龄项进行多元logistic回归分析，结果显示长期预后与年龄无明显相关(P>0.05)，而与是否合并心血管疾病和入院神志相关(P=0.001)。对于合并心血管疾病患者按照术后是否控制好心血管事件分组，在组间病死率和神经功能的恢复上差异均有统计学意义(分别P=0.006，P=0.001)。结论：在开颅动脉瘤夹闭术患者中，合并心血管疾病患者的短期和长期预后均差。术后控制好心血管事件可能降低其病死率，促进其神经功能的恢复。

Prognosis in patients underwent craniotomy for aneurysm clipping with cardiovascular diseases

Objective: To analyze the prognostic factors for patients with or without cardiovascular diseases after craniotomy for aneurysm clipping, and to provide evidences for the improvement of perioperative management in these patients. Methods: We collected 297 patients who underwent craniotomy for aneurysm clipping in Xiangya Hospital of Central South University from May 2016 to February 2017. The patients were divided into two groups: the cardiovascular disease group and the non-cardiovascular disease group. The perioperative clinical data, neurological function assessments at admission and discharge and Glasgow Outcome Scale (GOS) scores of one-year-follow-up after discharge were analyzed. The primary outcome of this study was the GOS scores collected at one year after discharge. The secondary outcomes were the lengths of their ICU stay, neurological functions at discharge and adverse events morbidity during the hospitalization. Results: A total of 241 patients were eventually enrolled. There was no significant difference in their general data between the two groups except for their ages. The GOS scores of the one-year-follow-up were significantly different between the two groups (P=0.007). The lengths of ICU stay, neurological dysfunctions at discharge and adverse events morbidity during hospitalization were also significantly different (P=0.036, P=0.011, P=0.005, respectively). A multivariate logistic regression analysis in which GOS score was the dependent variable with age adjusted also supported the previous results that long-term prognosis was not significantly correlated with the age of patients (P>0.05), but it was correlated with cardiovascular disease and sanity at admission (P=0.001). In patients with cardiovascular diseases, there was significantly different in perioperative mortality and neurological recovery of patients who had or had not cardiovascular events (P=0.006, P=0.001, respectively). Conclusion: Undergoing craniotomy for aneurysm clipping, patients with cardiovascular diseases have worse outcomes in both of short and long terms. Perioperative treatments for cardiovascular disease could not only improve postoperative neurological deficits, but also reduce mortality for these patients.