开颅动脉瘤夹闭术治疗老年颅内破裂动脉瘤预后不良因素分析

目的探讨开颅动脉瘤夹闭术治疗老年颅内破裂动脉瘤预后不良的影响因素。方法回顾性分析92例行开颅动脉瘤夹闭术治疗颅内破裂动脉瘤老年患者的临床资料。根据改良Rankin量表(mRS)评分,将患者分为预后良好组(0~2级)和预后不良组(3~6级)。评价开颅动脉瘤夹闭术治疗老年颅内破裂动脉瘤预后不良的影响因素,采用单因素、多因素Logistic回归分析影响患者开颅动脉瘤夹闭术预后不良的危险因素。结果根据mRS评分结果,92例患者中,预后不良46例,预后不良率为50%。单因素分析结果显示2组患者在性别、年龄、合并脑动脉粥样硬化、高血压、冠心病、术前Hunt-Hess分级、术前CT改良Fisher分级、术后低蛋白血症、术后脑梗死、术后脑积水方面比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示合并脑动脉粥样硬化、术前Hunt-Hess分级Ⅲ~Ⅳ级、术后脑梗死是开颅动脉瘤夹闭术治疗老年颅内破裂动脉瘤患者预后不良的独立危险因素。结论合并脑动脉粥样硬化、术前Hunt-Hess分级高、术后脑梗死是影响老年患者开颅动脉瘤夹闭术后近期预后不良的独立危险因素,为改善患者预后,术中应操作轻柔,以减少血管刺激;术后给予足够血容量,预防血管痉挛、改善循环等,以减少术后脑梗死发生;提倡健康生活方式,控制血压、血糖稳定,减少脑动脉粥样硬化的发生。

Analysis on poor prognostic factors of elderly patients with ruptured intracranial aneurysm treated by craniotomy aneurysm clipping

Objective To investigate the influencing factors of poor prognosis of elderly patients with ruptured intracranial aneurysm treated by craniotomy aneurysm clipping.Methods The clinical data of 92 elderly patients with ruptured intracranial aneurysm who underwent craniotomy aneurysm clipping were retrospectively analyzed,and they were divided into the good prognosis group(grade 0 to 2)and the poor prognosis group(grade 3 to 6)according to the modified Rankin scale(mRS)score.The influencing factors of poor prognosis of elderly patients with ruptured intracranial aneurysm treated by craniotomy aneurysm clipping were evaluated.Univariate and multivariate Logistic regression analysis were used to analyze the risk factors that affect the prognosis of patients with craniotomy aneurysm clipping.Results According to the results of mRS score,46 patients had poor prognosis among the 96 patients,and the poor prognosis rate was 50%.The results of univariate analysis showed that there were statistically significant differences in gender,age,cerebral atherosclerosis,hypertension,coronary heart disease,preoperative Hunt-Hess grade,preoperative CT modified Fisher grade,postoperative hypoproteinemia,postoperative cerebral infarction and postoperative hydrocephalus between the two groups(P<0.05).The results of multivariate Logistic regression analysis showed that cerebral atherosclerosis,preoperative Hunt-Hess gradeⅢtoⅣand postoperative cerebral infarction were the independent risk factors of poor prognosis of elderly patients with ruptured intracranial aneurysm treated by craniotomy aneurysm clipping.Conclusion Cerebral atherosclerosis,high preoperative Hunt-Hess grade and postoperative cerebral infarction are the independent risk factors of short-term poor prognosis of elderly patients after craniotomy aneurysm clipping.In order to improve the prognosis of patients,the operation should be gentle to reduce vascular irritation.Sufficient blood volume should be given after operation to prevent vasospasm and improve circulation,so as to reduce the occurrence of postoperative cerebral infarction.A healthy lifestyle should be advocated to control blood pressure and blood sugar stability,so as to reduce the occurrence of cerebral atherosclerosis.