颅内破裂动脉瘤介入栓塞患者早期预后相关因素分析

目的分析影响血管内介入栓塞治疗颅内破裂动脉瘤患者早期预后的重要相关因素。 方法收集右江民族医学院附属医院神经内外科疾病治疗中心自2014年1月到2018年6月收治的180例行血管内介入栓塞治疗的颅内破裂动脉瘤患者的临床资料，根据患者发病后1个月的改良Rankin量表评分，分成预后良好组（0~2分）和预后不良组（3~6分），通过单因素分析和多因素Logistic回归分析，筛选出影响患者预后不良的独立危险因素。 结果经单因素和多因素Logistic回归分析显示，入院时世界神经外科联盟分级（WFNSS）分型（OR=11.017，95%CI：4.153~29.229）、脑梗死（OR=10.325，95%CI：2.060~51.740）、手术中并发症（OR=6.917，95%CI：1.493~32.052）、急性梗阻性脑积水（OR=6.685，95%CI：2.171~20.587）是患者1个月预后不良的独立危险因素。受试者工作特征曲线的曲线下面积显示：急性梗阻性脑积水0.768（95%CI：0.689~0.846）、入院时WFNSS分型0.741（95%CI：0.661~0.821）、脑梗死0.658（95%CI：0.571~0.746）、手术中并发症0.609（95%CI：0.520~0.698）。 结论患者入院时的WFNSS在患者预后的因素中占主要地位，脑梗死是影响预后最主要的独立危险因素，临床治疗的关注点应该在如何减少栓塞术后再出血、脑梗死、脑积水等并发症，降低患者的死亡率和致残率，改善患者的预后。

Analysis of clinical factors related to early prognosis of patients with intracranial ruptured aneurysm treated by interventional embolization

ObjectiveTo analyze the related clinical factors with the prognosis of patients with intracranial ruptured aneurysm treated with endovascular interventional embolization. MethodsThe clinical data of 180 patients were consecutively collected from January 2014 to June 2018 in The Affiliated Hospital of Youjiang Medical University for Nationalities underwent intravascular interventional embolization of ruptured intracranial aneurysms. According to the modified rankin scale score at 1 month after bleeding, the patients were divided into the group with good prognosis (0-2 points) and the group with poor prognosis (3-6 points). Univariate analysis and multivariate Logistic regression analysis were used to screen out independent risk factors affecting poor prognosis of patients. ResultsUnivariate analysis and multivariate Logistic regression analysis showed that World Federation of Neurological Surgeons Scale (WFNSS) classification at admission (OR=11.017, 95%CI: 4.153-29.229), cerebral infarction (OR=10.325, 95%CI: 2.060-51.740), intraoperative complications (OR=6.917, 95%CI: 1.493-32.052) and acute obstructive hydrocephalus (OR=6.685, 95%CI: 2.171-20.587) were independent risk factors for poor prognosis at 1 month. The area under curve of receiver operating curve showed that acute obstructive hydrocephalus 0.768 (95%CI: 0.689-0.846); WFNSS typing at admission 0.741 (95%CI: 0.661-0.821), cerebral infarction 0.658 (95%CI: 0.571-0.746), intraoperative complications: 0.609 (95%CI: 0.520-0.698). ConclusionIt is demonstrated that the WFNSS of patients at admission plays a major role in the prognostic factors of patients and especially cerebral infarction is the most important independent risk factor affecting the prognosis. Clinical treatment should focus on how to reduce complications such as rehemorrhage after embolization, cerebral infarction and hydrocephalus, to reduce the death rate and disability rate of patients, and to improve the prognosis of patients.