颅内动脉瘤术后低血压反应的危险因素分析

目的总结颅内动脉瘤术后低血压的发生与预后的关系,明确术后低血压发生的危险因素。方法回顾性分析接受开颅动脉瘤手术的127例病例,使用Ridit分析研究低血压的发生与预后的相关性。以性别、年龄、术前Hunt-Hess分级、术前高血压病史、低钠血症、心电图改变、术前蛛网膜下腔出血程度、术前尼膜地平应用、手术时机的选择、术中脑室穿刺引流、术中载瘤动脉阻断时间、术中控制性降压持续时间、术中控制性降压程度、术中动脉瘤破裂与否等14个可能的危险因素为自变量,设定术后“发生低血压”为变量,使用logistic回归分析研究相关的危险因素。结果正常血压组预后优于低血压组。术前心电图改变、术前蛛网膜下腔出血程度、术中载流动脉阻断时间、术中动脉瘤破裂与否等4个因素为低血压发生的危险因素。结论动脉瘤病人术后低血压反应严重影响病人预后。针对低血压发生的危险因素的防治,有望减少和纠正低血压反应,改善预后。

Risk factors analysis for postoperative hypotension reaction in intracranial aneurysm

Objective To summarize the relationship between the postoperative hypotension reaction and prognosis of intracranial aneurysm patients, and to elucidate the risk factors of the hypotension reaction. Methods 127 cases of aneurysm operated in past 15 months were analyzed retrospectively. Ridit analysis was performed to summarize the relationship between hypotension and prognosis, and logistic regression was performed to elucidate the risk factors. Sex, age, Hunt-Hess rank, hypertension history, hyponatremia, abnormal cardiogram, SAH, employment of nimodipine, time of operation, ventricular drainage during the operation, time of artery occlusion, time and degree of controlling hypotension during operation, and rupture of aneurysm in surgery were set as independent variables. The occurring of postoperative hypotension reaction was set as dependent variable. Results The prognosis of normal blood pressure group was better than that of hypotension group. The abnormal cardiogram, SAH, time of artery occlusion, and rupture of aneurysm in surgery were risk factors of hypotension. Conclusion Since postoperative hypotension badly influences the prognosis of aneurysm patients, more attention should be taken on these dangerous complications. Treatment aiming at those risk factors would decrease the occurring of hypotension and promote the prognosis of intracranial aneurysm.