老年颅内破裂动脉瘤患者手术预后影响因素分析

目的探讨影响老年颅内破裂动脉瘤患者行开颅动脉瘤夹闭术预后的因素。 方法回顾分析老年颅内破裂动脉瘤患者74例，依据患者术后6个月时改良Rankin评分（Modified Rankin Scale，mRS）分为预后良好组(mRS 0~2分)45例和较差组（mRS 3~6分）29例，并对可能影响手术预后的因素进行分析。 结果2组在性别、高血压、糖尿病、冠心病、吸烟史、饮酒史、抗血小板或抗凝史、脑出血病史、动脉瘤部位、多发动脉瘤、手术时间、再出血、癫痫、非神经系统严重症状差异无统计学意义（P＞0.05）。预后良好组在年龄≥70岁、Hunt-Hess分级Ⅲ~Ⅴ级、合并虚弱症、手术时机＞3 d、动脉瘤直径≥7 mm、发生脑缺血卒中和脑积水比例比预后较差组更低，差异有统计学意义（P＜0.05或P＜0.01）。多因素Logistic回归分析结果显示，Hunt-Hess分级、虚弱症、手术时机及脑缺血卒中对预后有影响，差异有统计学意义（P＜0.05），而年龄、动脉瘤直径及脑积水对结果无影响，差异无统计学意义（P＞0.05）。 结论老年颅内破裂动脉瘤患者行开颅手术的预后受多种因素影响，Hunt-Hess分级、虚弱症、手术时机、脑缺血卒中是重要的影响因素。

Analysis of prognostic factors in elderly patients with ruptured intracranial aneurysms

ObjectiveTo investigate the influencing factors affecting the prognosis of ruptured intracranial aneurym surgery in the elderly patiens. MethodsSeventy-four elderly patients with ruptured intracranial aneurysms were retrospectively analyzed. According to the Modified Rankin Scale(mRS) 6 months after surgery, 45 patients were divided into the good prognosis group(mRS 0-2 points) and 29 patients into the poor prognosis group(mRS 3-6 points). The influencing factors that may affect the prognosis of the surgery were analyzed. ResultsThere were no significant differences in gender, hypertension, diabetes, coronary heart disease, smoking history, alcohol history, history of anti-platelet or anti-coagulation medications, history of cerebral hemorrhage, aneurysm site, multiple aneurysms, operation time, rebleeding, epilepsy, and severe symptoms of non-nervous system between the two groups(P＞0.05). The good prognosis group had lower proportion of patients with age ≥ 70 years old, Hunt-Hess grade Ⅲ-Ⅴ, frailty, timing of operation >3 days, aneurysm diameter ≥7 mm, cerebral ischemic stroke and hydrocephalus than the poor prognosis group, and the differences were statistically significant(P＜0.05 or P＜0.01). The Resultsof multivariate Logistic regression analysis showed that Hunt-Hess grade, frailty, timing of operation and cerebral ischemic stroke could influence the prognosis, with statistically significant differences(P＜0.05). While age, aneurysm diameter and hydrocephalus had no effects on the prognosis, with no statistically significant differences(P＞0.05). ConclusionThe prognosis of aneurysm surgery is affected by a number of factors. Hunt-Hess grade, risk score, timing of surgery and post-operative cerebral infarction are the important factors.