血管内治疗颅内破裂动脉瘤后发生神经系统并发症的相关因素分析
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摘要
目的分析颅内破裂动脉瘤(rupture intracranial aneurysms,RIAs)患者血管内治疗(endovascular treatment,EVT)相关的神经系统并发症的影响因素,为RIAs患者的EVT治疗提供参考。方法选取2012年3月—2017年1月在金华市人民医院诊断且符合纳入标准的75例RIAs患者为研究对象,对其行EVT治疗,术后随访6个月,根据术后EVT治疗相关的神经系统并发症发生情况,将术后出现EVT相关神经系统并发症的患者纳入并发症发生组(24例),将术后未出现相关并发症的患者纳入并发症未发生组(51例),对比2组患者的一般资料(性别、年龄、高血压、糖尿病、脑梗死病史、Hunt-Hess分级、Fisher分级等)、动脉瘤相关指标(动脉瘤的数量、最大直径、位置、形态、瘤囊及主动脉弓分型情况等)、EVT治疗情况(手术次数、手术方式、破裂至栓塞时间、栓塞效果及血钠水平)的差异,并采用二元Logistic回归分析影响RIAs患者EVT治疗相关的神经系统并发症的因素。结果并发症未发生组患者的高血压、Hunt-Hess分级、Fisher分级、瘤囊、宽颈动脉瘤情况、手术方式及血钠水平与并发症发生组比较,差异有统计学意义(均P <0. 05);患者的Hunt-Hess分级、手术方式、瘤囊及宽颈动脉瘤情况是影响RIAs患者EVT治疗相关神经系统并发症的主要因素。结论 Hunt-Hess分级、手术方式、瘤囊及宽颈动脉瘤情况是RIAs患者EVT治疗相关的神经系统并发症的影响因素。
Objective To analyze the influence factors of neurologic complications associated with endovascular treatment( EVT) in patients with rupture intracranial aneurysms( RIAs) and provide a reference for the clinical treatment of EVT in RIAs patients. Methods A total of 75 cases of RIAs meeting the inclusion criteria in our hospital from Mach 2012 to January 2017 were enrolled into this study. The patients were treated with EVT and followed up for 6 months. According to the neurologic complications after EVT therapy,the patients with EVT associated neurological complications were included in the complication group( n = 24),and the patients without the associated complications were included in the uncomplicated group( n = 51). The general data( gender,age,hypertension,diabetes,cerebral infarction history,HuntHess classification and CT Fisher classification,etc),aneurysms related indicators( the number of aneurysms,the maximum diameter,position,shape,tumor cyst and aortic arch typing. etc) and EVT treatment( surgical procedures,surgical methods,rupture to embolization time,embolization effect and blood sodium level) were compared between the two groups. The binary logistic was performed to analyze the influence factors of neurologic complications associated with EVT in RIAs patients. Results The hypertension,Hunt-Hess classification,Fisher classification,tumor cyst,wide-necked aneurysm,surgical methods and blood sodium level in uncomplicated group were significantly differences with the complication group( P < 0. 05). The main influence factors of neurologic complications in RIAs associated with EVT were the Hunt-Hess classification,surgical methods,tumor cyst and wide-necked aneurysm. Conclusion The Hunt-Hess classification,surgical methods,tumor cyst and wide-necked aneurysm are the influence factors of neurologic complications associated with EVT in RIAs patients.
Objective To analyze the influence factors of neurologic complications associated with endovascular treatment( EVT) in patients with rupture intracranial aneurysms( RIAs) and provide a reference for the clinical treatment of EVT in RIAs patients. Methods A total of 75 cases of RIAs meeting the inclusion criteria in our hospital from Mach 2012 to January 2017 were enrolled into this study. The patients were treated with EVT and followed up for 6 months. According to the neurologic complications after EVT therapy,the patients with EVT associated neurological complications were included in the complication group( n = 24),and the patients without the associated complications were included in the uncomplicated group( n = 51). The general data( gender,age,hypertension,diabetes,cerebral infarction history,HuntHess classification and CT Fisher classification,etc),aneurysms related indicators( the number of aneurysms,the maximum diameter,position,shape,tumor cyst and aortic arch typing. etc) and EVT treatment( surgical procedures,surgical methods,rupture to embolization time,embolization effect and blood sodium level) were compared between the two groups. The binary logistic was performed to analyze the influence factors of neurologic complications associated with EVT in RIAs patients. Results The hypertension,Hunt-Hess classification,Fisher classification,tumor cyst,wide-necked aneurysm,surgical methods and blood sodium level in uncomplicated group were significantly differences with the complication group( P < 0. 05). The main influence factors of neurologic complications in RIAs associated with EVT were the Hunt-Hess classification,surgical methods,tumor cyst and wide-necked aneurysm. Conclusion The Hunt-Hess classification,surgical methods,tumor cyst and wide-necked aneurysm are the influence factors of neurologic complications associated with EVT in RIAs patients.
引文
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[9]郑燕国,叶仙华,李军,等.神经外科血管介入手术麻醉复苏的临床效果分析[J].中华全科医学,2015,13(11):1895.
[10] ZHANG J Z,WU X,HUANG Q H. Mechanism of hemodynamics induces vascular inflammation in the pathogenesis of intracranial aneurysms[J]. Stroke,2014,11(7):381-384.
[11] OGILVY C S,CHUA M H,FUSCO M R,et al. Stratification of Recanalization for Patients With Endovascular Treatment of Intracranial Aneurysms[J]. Neurosurgery,2015,76(4):390-395.
[12]闵杰,张双,杨磊,等. Hunt-HessⅣ~Ⅴ级动脉瘤性蛛网膜下腔出血患者预后影响因素的研究[J].实用临床医药杂志,2016,20(19):163-165.
[13]王琳玺,廉庆北,徐善才,等.动脉瘤性蛛网膜下腔出血的治疗进展与探讨[J].现代生物医学进展,2015,15(13):2540-2542.
[14] KIENZLER J,MARBACHER S,REMONDA L,et al. Outcome after In-Hospital Rebleeding of Rupture of Intracranial Aneurysms[J]. J Neurol Surg A Cent Eur Neurosurg,2016,77(3):207-221.
[15] WAN J,GU W,ZHANG X,et al. Endovascular coil embolization of aneurysm neck for the treatment of ruptured intracranial aneurysm with bleb formation[J]. Med Sci Monit,2014,20(2):1121-1128.
[16]陈三送,方兴根,李真保,等. Enterprise支架辅助栓塞颅内动脉瘤并发症原因分析及处理[J].中国脑血管病杂志,2015,12(8):421-425,434.
[17]黄青良,桂勇平,杜建胜,等.支架辅助弹簧圈栓塞颅内宽颈动脉瘤的常见并发症分析[J].实用医学杂志,2016,32(3):450-452.
[18] CHUNG J,LIM Y C,SUH S H,et al. Stent-assisted coil embolization of ruptured wide-necked aneurysms in the acute period:incidence of and risk factors for periprocedural complications[J]. J Neurol,2014,121(1):4-11.
[19]冯明陶,冯政哲,方亦斌,等.支架与非支架辅助弹簧圈栓塞治疗颅内动脉瘤的Meta分析[J].中国脑血管病杂志,2016,13(1):17-24.
[20]徐兴国,杨振兴,陈一笑,等.血管内治疗破裂颅内动脉瘤患者的预后影响因素分析[J].中华神经外科杂志,2017,33(1):49-53.
[2]程旭峰,傅先明,钱若兵,等.栓塞治疗颅内破裂动脉瘤术中再破裂的危险因素分析[J].安徽医学,2017,38(6):679-683.
[3]李明武,刘伟,郭庆东.支架辅助弹簧圈栓塞治疗破裂颅内动脉瘤研究进展[J].中华神经外科疾病研究杂志,2016,15(6):555-557.
[4]马修尧,任超,王强,等.超早期和早期血管内介入治疗对HuntHess高分级颅内动脉瘤破裂的安全性和有效性比较[J].中华全科医学,2018,16(3):356-359.
[5] LIU J,LI X,SUN S,et al. Clinical and Angiographic Outcomes of Endovascular Treatment for Ruptured Posterior Circulation Cerebral Aneurysms[J]. Turk Neurosurg,2016,26(4):513-517.
[6]呼铁民,田甜,王昆鹏,等.开颅夹闭术与血管内介入动脉瘤栓塞术治疗中青年高危颅内动脉瘤破裂效果的比较研究[J].实用心脑肺血管病杂志,2015,23(7):81-84.
[7] CHEN J X,LAI L F,ZHENG K,et al. Influencing factors of immediate angiographic results in intracranial aneurysms patients after endovascular treatment[J]. J Neurol,2015,262(9):2115-2123.
[8]刘超,门秀丽,石秋艳.血管内栓塞治疗老年颅内动脉瘤破裂33例临床观察[J].中国煤炭工业医学杂志,2015,18(3):378-380.
[9]郑燕国,叶仙华,李军,等.神经外科血管介入手术麻醉复苏的临床效果分析[J].中华全科医学,2015,13(11):1895.
[10] ZHANG J Z,WU X,HUANG Q H. Mechanism of hemodynamics induces vascular inflammation in the pathogenesis of intracranial aneurysms[J]. Stroke,2014,11(7):381-384.
[11] OGILVY C S,CHUA M H,FUSCO M R,et al. Stratification of Recanalization for Patients With Endovascular Treatment of Intracranial Aneurysms[J]. Neurosurgery,2015,76(4):390-395.
[12]闵杰,张双,杨磊,等. Hunt-HessⅣ~Ⅴ级动脉瘤性蛛网膜下腔出血患者预后影响因素的研究[J].实用临床医药杂志,2016,20(19):163-165.
[13]王琳玺,廉庆北,徐善才,等.动脉瘤性蛛网膜下腔出血的治疗进展与探讨[J].现代生物医学进展,2015,15(13):2540-2542.
[14] KIENZLER J,MARBACHER S,REMONDA L,et al. Outcome after In-Hospital Rebleeding of Rupture of Intracranial Aneurysms[J]. J Neurol Surg A Cent Eur Neurosurg,2016,77(3):207-221.
[15] WAN J,GU W,ZHANG X,et al. Endovascular coil embolization of aneurysm neck for the treatment of ruptured intracranial aneurysm with bleb formation[J]. Med Sci Monit,2014,20(2):1121-1128.
[16]陈三送,方兴根,李真保,等. Enterprise支架辅助栓塞颅内动脉瘤并发症原因分析及处理[J].中国脑血管病杂志,2015,12(8):421-425,434.
[17]黄青良,桂勇平,杜建胜,等.支架辅助弹簧圈栓塞颅内宽颈动脉瘤的常见并发症分析[J].实用医学杂志,2016,32(3):450-452.
[18] CHUNG J,LIM Y C,SUH S H,et al. Stent-assisted coil embolization of ruptured wide-necked aneurysms in the acute period:incidence of and risk factors for periprocedural complications[J]. J Neurol,2014,121(1):4-11.
[19]冯明陶,冯政哲,方亦斌,等.支架与非支架辅助弹簧圈栓塞治疗颅内动脉瘤的Meta分析[J].中国脑血管病杂志,2016,13(1):17-24.
[20]徐兴国,杨振兴,陈一笑,等.血管内治疗破裂颅内动脉瘤患者的预后影响因素分析[J].中华神经外科杂志,2017,33(1):49-53.