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  • 唐海双,贺晓武,左乔,薛盖茨,张小曦,许奕,洪波,黄清海,刘建民*.支架辅助弹簧圈栓塞治疗急性期颅内破裂动脉瘤的围手术期危险因素分析[J].第二军医大学学报,2019,40(2):117-124    [点击复制]
  • TANG Hai-shuang,HE Xiao-wu,ZUO Qiao,XUE Gai-ci,ZHANG Xiao-xi,XU Yi,HONG Bo,HUANG Qing-hai,LIU Jian-min*.Perioperative risk factors of stent-assisted coiling for acute ruptured intracranial aneurysm[J].Acad J Sec Mil Med Univ,2019,40(2):117-124   [点击复制]
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支架辅助弹簧圈栓塞治疗急性期颅内破裂动脉瘤的围手术期危险因素分析
唐海双,贺晓武,左乔,薛盖茨,张小曦,许奕,洪波,黄清海,刘建民*
0
(海军军医大学(第二军医大学)长海医院神经外科, 上海 200433
*通信作者)
摘要:
目的 探讨支架辅助弹簧圈栓塞(SAC)治疗急性期(≤28 d)颅内破裂动脉瘤(RIA)围手术期技术相关并发症及临床预后的影响因素。方法 回顾性连续纳入2012年1月至2018年6月在海军军医大学(第二军医大学)长海医院接受SAC治疗的急性期RIA患者,对其临床及影像学资料进行单因素分析及多因素logistic回归分析,筛选可能存在的围手术期技术相关并发症及预后的危险因素。结果 最终接受SAC治疗并完成30 d随访的急性期RIA患者共509例,其中男170例、女339例。28例(5.5%)患者围手术期发生缺血并发症,多因素分析结果显示动脉瘤位于血管分叉处是SAC治疗急性期RIA患者围手术期发生缺血并发症的独立危险因素[比值比(OR)=4.108,P=0.001]。25例(4.9%)患者围手术期发生出血并发症,多因素分析结果显示年龄<60岁是SAC治疗急性期RIA患者围手术期发生出血并发症的独立危险因素(OR=3.574,P=0.014)。出院改良Rankin量表(mRS)评分为3~5分的患者81例(15.9%),死亡(mRS评分为6分)27例(5.3%),预后不良(mRS评分>2分)率为21.2%(108/509);多因素分析结果显示年龄≥80岁、入院时高Hunt-Hess分级(3~5级)、围手术期发生缺血并发症、围手术期发生出血并发症、入院格拉斯哥昏迷量表(GCS)评分差是急性期RIA患者SAC治疗后预后不良的独立危险因素(P均<0.01)。结论 对于SAC治疗的急性期RIA患者,动脉瘤位于血管分叉处是围手术期发生缺血并发症的独立危险因素;年龄<60岁是围手术期发生出血并发症的独立危险因素;入院时GCS评分较差的患者出院时临床预后较差,围手术期发生缺血及出血并发症是预后不良的独立危险因素。
关键词:  颅内动脉瘤  蛛网膜下隙出血  支架  神经系统并发症
DOI:10.16781/j.0258-879x.2019.02.0117
投稿时间:2019-01-14修订日期:2019-02-02
基金项目:国家重点研发计划重大慢性非传染性疾病防控研究重点专项(2016YFC1300700),国家卫生和计划生育委员会脑卒中防治工程“中国脑卒中高危人群干预适宜技术研究及推广项目”(GN-2018R0001),国家自然科学基金(81701136).
Perioperative risk factors of stent-assisted coiling for acute ruptured intracranial aneurysm
TANG Hai-shuang,HE Xiao-wu,ZUO Qiao,XUE Gai-ci,ZHANG Xiao-xi,XU Yi,HONG Bo,HUANG Qing-hai,LIU Jian-min*
(Department of Neurosurgery, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author)
Abstract:
Objective To explore the influencing risk factors of perioperative technical complications and clinical prognosis of stent-assisted coiling (SAC) for acute (≤ 28 d) ruptured intracranial aneurysm (RIA). Methods Acute RIA patients, who received SAC treatment in Changhai Hospital of Naval Medical University (Second Military Medical University) between Jan. 2012 and Jun. 2018, were retrospectively enrolled. The clinical and imaging data were analyzed using univariable analysis and multivariate logistic regression analysis to identify the potential risk factors of perioperative technical complications and clinical prognosis. Results A total of 509 acute RIA patients (170 males and 339 females), who underwent SAC treatment and received 30-d follow-up, were included in this study. Perioperative ischemic complications occurred in 28 cases (5.5%), and multivariate regression analysis showed that the location of aneurysms at the bifurcation of blood vessels was an independent risk factor of ischemic complications (odds ratio[OR]=4.108, P=0.001). Perioperative hemorrhagic complications occurred in 25 cases (4.9%), and multivariate regression analysis showed that age<60 years was an independent risk factor of hemorrhagic complications (OR=3.574, P=0.014). The modified Rankin scale (mRS) scores of 81 patients (15.9%) ranged from 3 to 5 at discharge, 27 patients (5.3%) died with mRS score of 6, and the poor prognosis (mRS score>2) rate was 21.2% (108/509). Multivariate regression analysis showed that age ≥ 80 years, Hunt-Hess 3-5 class, perioperative ischemic complications, perioperative hemorrhagic complications and poor Glasgow coma scale (GCS) score were independent risk factors of poor prognosis (all P<0.01). Conclusion For the acute RIA patients treated with SAC, the location of aneurysms at the vascular bifurcation is an independent risk factor of perioperative ischemic complications; age<60 years is an independent risk factor for hemorrhagic complications; and the patients with poor GCS score at admission have a poor prognosis at discharge, and perioperative ischemic and hemorrhagic complications are independent risk factors of poor prognosis.
Key words:  intracranial aneurysm  subarachnoid hemorrhage  stents  neurologic complications