颅内动脉瘤急症介入术后神经系统并发症相关因素探讨
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摘要
目的探讨颅内动脉瘤急症介入术后发生神经系统并发症的相关因素。方法收集2010年1月至2017年12月采用急症介入术治疗的颅内动脉瘤破裂患者453例临床资料。根据是否发生神经系统并发症分为并发症组和无并发症组。观察分析患者并发症发生情况和发生率,并通过单因素统计分析及多因素logistic回归分析探讨并发症发生原因及独立危险因素。结果 453例患者中共有59例(13.0%)发生神经系统并发症,多为血栓栓塞,其次为术后早期再破裂出血和术中动脉瘤破裂。单因素分析结果显示,有高血压病史、脑梗死病史、Fisher分级Ⅲ～Ⅳ级、WFNS分级Ⅲ～Ⅴ级、Hunt-Hess分级Ⅳ～Ⅴ级以及宽颈动脉瘤、动脉瘤囊有小阜和瘤体形态不规则患者神经系统并发症发生率明显更高(P<0.05)。多因素logistic回归分析显示,有高血压病史、宽颈动脉瘤、动脉瘤囊有小阜、瘤体形态不规则以及Fisher分级Ⅲ～Ⅳ级、WFNS分级Ⅲ～Ⅴ级、Hunt-Hess分级Ⅳ～Ⅴ级为介入术后发生神经系统并发症的独立危险因素(P<0.05)。结论临床治疗急症颅内动脉瘤中对有高血压病史、宽颈动脉瘤、动脉瘤囊有小阜、瘤体形态不规则以及Fisher分级Ⅲ～Ⅳ级、WFNS分级Ⅲ～Ⅴ级、Hunt-Hess分级Ⅳ～Ⅴ级患者应予以重视,给予针对性治疗,以减少神经系统并发症发生。
Objective To discuss the related factors of neurological complications after emergency intervention for intracranial aneurysms. Methods The clinical data of 453 patients with ruptured intracranial aneurysms, who received emergency interventional therapy during the period from January 2010 to December2017, were collected. According to whether neurological complications occurred or not, the patients were divided into complication group and non-complication group. The complication and its incidence were recorded and analyzed. Using single factor statistical analysis and multivariate Logistic regression analysis the causes of complications and independent risk factors were analyzed and discussed. Results Of the 453 patients, 59(13.0%) developed neurological complications, the main complication was thromboembolism,and the next common complications were early postoperative rerupture with hemorrhage and rupture of aneurysm during operation. Single factor analysis results showed that the incidence of neurological complications was significantly higher in patients who had history of hypertension, history of cerebral infarction, Fisher grade Ⅲ-Ⅳ, WFNS grade Ⅲ-Ⅴ, Hunt-Hess grade Ⅳ-Ⅴ, wide-necked aneurysms,aneurysm sac with caruncle and irregular aneurysm shape(P<0.05). Multivariate Logistic regression analysis indicated that history of hypertension, wide carotid aneurysm, aneurysm sac with caruncle, irregular aneurysm shape, Fisher grade Ⅲ-Ⅳ, WFNS grade Ⅲ-Ⅴ, Hunt-Hess grade Ⅳ-Ⅴ were independent risk factors for the occurrence of neurological complications after interventional treatment(P<0.05). Conclusion Clinically, in treating ruptured intracranial aneurysms with emergency interventional management utmost attention should be paid to these patients who have history of hypertension, wide carotid aneurysm, aneurysm sac with caruncle, irregular aneurysm shape, Fisher grade Ⅲ-Ⅳ, WFNS grade Ⅲ-Ⅴ, Hunt-Hess grade Ⅳ-Ⅴ. For these patients, individualized and targeted treatment should be formulated so as to reduce the incidence of neurological complications.
Objective To discuss the related factors of neurological complications after emergency intervention for intracranial aneurysms. Methods The clinical data of 453 patients with ruptured intracranial aneurysms, who received emergency interventional therapy during the period from January 2010 to December2017, were collected. According to whether neurological complications occurred or not, the patients were divided into complication group and non-complication group. The complication and its incidence were recorded and analyzed. Using single factor statistical analysis and multivariate Logistic regression analysis the causes of complications and independent risk factors were analyzed and discussed. Results Of the 453 patients, 59(13.0%) developed neurological complications, the main complication was thromboembolism,and the next common complications were early postoperative rerupture with hemorrhage and rupture of aneurysm during operation. Single factor analysis results showed that the incidence of neurological complications was significantly higher in patients who had history of hypertension, history of cerebral infarction, Fisher grade Ⅲ-Ⅳ, WFNS grade Ⅲ-Ⅴ, Hunt-Hess grade Ⅳ-Ⅴ, wide-necked aneurysms,aneurysm sac with caruncle and irregular aneurysm shape(P<0.05). Multivariate Logistic regression analysis indicated that history of hypertension, wide carotid aneurysm, aneurysm sac with caruncle, irregular aneurysm shape, Fisher grade Ⅲ-Ⅳ, WFNS grade Ⅲ-Ⅴ, Hunt-Hess grade Ⅳ-Ⅴ were independent risk factors for the occurrence of neurological complications after interventional treatment(P<0.05). Conclusion Clinically, in treating ruptured intracranial aneurysms with emergency interventional management utmost attention should be paid to these patients who have history of hypertension, wide carotid aneurysm, aneurysm sac with caruncle, irregular aneurysm shape, Fisher grade Ⅲ-Ⅳ, WFNS grade Ⅲ-Ⅴ, Hunt-Hess grade Ⅳ-Ⅴ. For these patients, individualized and targeted treatment should be formulated so as to reduce the incidence of neurological complications.
引文
[1]段国礼,诸德源,张晓曦,等.颅内破裂动脉瘤老年患者介入治疗神经系统并发症的危险因素分析[J].中国脑血管病杂志,2017,14:4-9.
[2]谭华桥,周育苗,方淳,等.血管内介入治疗周围型颅内动脉瘤17例[J].介入放射学杂志,2016,25:279-285.
[3]Liu H,Park D,Hwang SM,et al.Outpatient day-care neuroangiography and neurointervention of unruptured intracranial aneurysms[J].Neurointervention,2016,11:37-41.
[4]侯青,徐跃峤,程玮涛,等.支架辅助弹簧圈栓塞颅内动脉瘤围手术期严重神经系统并发症的分析[J].中国脑血管病杂志,2016,13:262-265.
[5]Rozell JM,Mtui E,Pan YN,et al.Infectious and inflammatory diseases of the central nervous system.The spectrum of imaging findings and differential diagnosis[J].Emerg Radiol,2017,24:619-633.
[6]陈宗涛.影响颅内动脉瘤介入治疗预后的相关因素分析[J].医学临床研究,2017,34:2437-2438.
[7]Ruggieri M,Milone P,Pavone P,et al.Nevus vascularis mixtus(cutaneous vascular twin nevi)associated with intracranial vascular malformation of the Dyke-Davidoff-Masson type in two patients[J].Am J Med Genet A,2012,158A:2870-2880.
[8]杨少春,黄小玉,邱传珍,等.颅内破裂微小动脉瘤介入栓塞治疗技术探讨[J].介入放射学杂志,2016,25:11-14.
[9]Cataltepe S,Arikan MC,Liang X,et al.Fatty acid binding protein 4 expression in cerebral vascular malformations:implications for vascular remodelling[J].Neuropathol Appl Neurobiol,2015,41:646-656.
[10]李星海,赵卫,杨净松,等.脑动静脉畸形伴发动脉瘤的出血风险因素分析及介入治疗[J].中国介入影像与治疗学,2018,15:204-208.
[11]卡合尔曼·卡德尔,阿西木江·阿西尔,特吾尔巴提·苏尔丹尼亚,等.小脑动脉远端动脉瘤的介入治疗[J].中国微侵袭神经外科杂志,2016,21:533-535.
[12]Shankar JJ,Lum C,Chakraborty S,et al.Cerebral vascular malformations:time-resolved CT angiography compared to DSA[J].Neuroradiol J,2015,28:310-315.
[13]Josephson CB,Rosenow F,Salman RA.Intracranial vascular malformations and epilepsy[J].Semin Neurol,2015,35:223-234.
[14]方娟,石先琴.脑肿瘤合并脑血管畸形的高危因素分析[J].现代肿瘤医学,2016,24:1045-1048.
[15]Qassim AM,Guan S,Saidi H,et al.Effectiveness of MRA on embolized intracranial aneurysms:a comparison of DSA,CE-MRA,and TOF-MRA[J].J Intervent Med,2018,1:32-41.
[16]霍晓川,李佑祥,江裕华,等.Onyx胶栓塞结合伽玛刀治疗颅内动静脉畸形的疗效分析[J].中华神经外科杂志,2015,31:1126-1130.
[17]Choudhri O,Ivan ME,Lawton MT.Transvenous approach to intracranial arteriovenous malformations:challenging the axioms of arteriovenous malformation therapy?[J].Neurosurgery,2015,77:644-651.
[18]Youssef M,Zerwes S,Jakob R,et al.Endovascular aneurysm sealing(EVAS)and chimney EVAS in the treatment of failed endovascular aneurysm repairs[J].J Endovasc Ther,2017,24:115-120.
[19]张彦冰,管生,郭新宾,等.颅内动脉瘤介入治疗围术期缺血并发症病因分析与防治(附48例报告)[J].介入放射学杂志,2017,26:291-295.
[20]Ruhnke H,Kroencke TJ.Visceral artery aneurysms and pseudoaneurysms:retrospective analysis of interventional endovascular therapy of 43 aneurysms[J].Rofo,2017,189:632-639.
[2]谭华桥,周育苗,方淳,等.血管内介入治疗周围型颅内动脉瘤17例[J].介入放射学杂志,2016,25:279-285.
[3]Liu H,Park D,Hwang SM,et al.Outpatient day-care neuroangiography and neurointervention of unruptured intracranial aneurysms[J].Neurointervention,2016,11:37-41.
[4]侯青,徐跃峤,程玮涛,等.支架辅助弹簧圈栓塞颅内动脉瘤围手术期严重神经系统并发症的分析[J].中国脑血管病杂志,2016,13:262-265.
[5]Rozell JM,Mtui E,Pan YN,et al.Infectious and inflammatory diseases of the central nervous system.The spectrum of imaging findings and differential diagnosis[J].Emerg Radiol,2017,24:619-633.
[6]陈宗涛.影响颅内动脉瘤介入治疗预后的相关因素分析[J].医学临床研究,2017,34:2437-2438.
[7]Ruggieri M,Milone P,Pavone P,et al.Nevus vascularis mixtus(cutaneous vascular twin nevi)associated with intracranial vascular malformation of the Dyke-Davidoff-Masson type in two patients[J].Am J Med Genet A,2012,158A:2870-2880.
[8]杨少春,黄小玉,邱传珍,等.颅内破裂微小动脉瘤介入栓塞治疗技术探讨[J].介入放射学杂志,2016,25:11-14.
[9]Cataltepe S,Arikan MC,Liang X,et al.Fatty acid binding protein 4 expression in cerebral vascular malformations:implications for vascular remodelling[J].Neuropathol Appl Neurobiol,2015,41:646-656.
[10]李星海,赵卫,杨净松,等.脑动静脉畸形伴发动脉瘤的出血风险因素分析及介入治疗[J].中国介入影像与治疗学,2018,15:204-208.
[11]卡合尔曼·卡德尔,阿西木江·阿西尔,特吾尔巴提·苏尔丹尼亚,等.小脑动脉远端动脉瘤的介入治疗[J].中国微侵袭神经外科杂志,2016,21:533-535.
[12]Shankar JJ,Lum C,Chakraborty S,et al.Cerebral vascular malformations:time-resolved CT angiography compared to DSA[J].Neuroradiol J,2015,28:310-315.
[13]Josephson CB,Rosenow F,Salman RA.Intracranial vascular malformations and epilepsy[J].Semin Neurol,2015,35:223-234.
[14]方娟,石先琴.脑肿瘤合并脑血管畸形的高危因素分析[J].现代肿瘤医学,2016,24:1045-1048.
[15]Qassim AM,Guan S,Saidi H,et al.Effectiveness of MRA on embolized intracranial aneurysms:a comparison of DSA,CE-MRA,and TOF-MRA[J].J Intervent Med,2018,1:32-41.
[16]霍晓川,李佑祥,江裕华,等.Onyx胶栓塞结合伽玛刀治疗颅内动静脉畸形的疗效分析[J].中华神经外科杂志,2015,31:1126-1130.
[17]Choudhri O,Ivan ME,Lawton MT.Transvenous approach to intracranial arteriovenous malformations:challenging the axioms of arteriovenous malformation therapy?[J].Neurosurgery,2015,77:644-651.
[18]Youssef M,Zerwes S,Jakob R,et al.Endovascular aneurysm sealing(EVAS)and chimney EVAS in the treatment of failed endovascular aneurysm repairs[J].J Endovasc Ther,2017,24:115-120.
[19]张彦冰,管生,郭新宾,等.颅内动脉瘤介入治疗围术期缺血并发症病因分析与防治(附48例报告)[J].介入放射学杂志,2017,26:291-295.
[20]Ruhnke H,Kroencke TJ.Visceral artery aneurysms and pseudoaneurysms:retrospective analysis of interventional endovascular therapy of 43 aneurysms[J].Rofo,2017,189:632-639.
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