中华神经医学杂志
中華神經醫學雜誌
중화신경의학잡지
CHINESE JOURNAL OF NEUROMEDICINE
2011年
2期
169-174
,共6页
龙霄翱%陈兵%陈立一%方琦%梁远生
龍霄翱%陳兵%陳立一%方琦%樑遠生
룡소고%진병%진립일%방기%량원생
颅内动脉瘤%栓塞,治疗性%并发症
顱內動脈瘤%栓塞,治療性%併髮癥
로내동맥류%전새,치료성%병발증
Intracranial aneurysm%Embolization,therapeutic%Complication
目的 探讨破裂性颅内动脉瘤介入术中再破裂的危险因素、应急处理办法及疗效.方法分析自2005年至2009年广东医学院附属医院神经外科收治的236例行介入治疗的破裂性颅内动脉瘤患者的临床资料,应用非条件logistic逐步回归方法分析其介入术中再破裂的危险因素,并总结其中发生再破裂的16例患者(6.78%)的处理措施及疗效. 结果 破裂性颅内动脉瘤介入术中再破裂的危险因素为:微小动脉瘤(OR=6.353,95%CI:1.26～31.894,P=0.025),A1、M1远端动脉瘤(OR=35.449,95%CI:3.053～411.642,P=0.004),动脉粥样硬化(OR=5.961,95%CI:1.215～29.260,P=0.028),轻度脑血管痉挛(OR=13.048,95%CI:1.220～139.574,P=0.034),重度脑血管痉挛(OR=14.826,95%CI:1.871～117.488,P=0.011).16例患者均采用鱼精蛋白快速中和肝素及迅速完成动脉瘤的栓塞,其中12例Hunt-HessⅢ级以上者予急诊行脑室外引流术,结果6例死亡,1例植物生存状态,9例恢复良好. 结论 动脉硬化,脑血管痉挛,微小动脉瘤,A1、M1远端动脉瘤等因素容易导致破裂性颅内动脉瘤介入术中再破裂.快速中和肝素及迅速完成动脉瘤的栓塞,对重症患者行急诊脑室外引流术是应对介入术中动脉瘤再破裂的关键,有利于病死率降低,预后改善.
目的 探討破裂性顱內動脈瘤介入術中再破裂的危險因素、應急處理辦法及療效.方法分析自2005年至2009年廣東醫學院附屬醫院神經外科收治的236例行介入治療的破裂性顱內動脈瘤患者的臨床資料,應用非條件logistic逐步迴歸方法分析其介入術中再破裂的危險因素,併總結其中髮生再破裂的16例患者(6.78%)的處理措施及療效. 結果 破裂性顱內動脈瘤介入術中再破裂的危險因素為:微小動脈瘤(OR=6.353,95%CI:1.26～31.894,P=0.025),A1、M1遠耑動脈瘤(OR=35.449,95%CI:3.053～411.642,P=0.004),動脈粥樣硬化(OR=5.961,95%CI:1.215～29.260,P=0.028),輕度腦血管痙攣(OR=13.048,95%CI:1.220～139.574,P=0.034),重度腦血管痙攣(OR=14.826,95%CI:1.871～117.488,P=0.011).16例患者均採用魚精蛋白快速中和肝素及迅速完成動脈瘤的栓塞,其中12例Hunt-HessⅢ級以上者予急診行腦室外引流術,結果6例死亡,1例植物生存狀態,9例恢複良好. 結論 動脈硬化,腦血管痙攣,微小動脈瘤,A1、M1遠耑動脈瘤等因素容易導緻破裂性顱內動脈瘤介入術中再破裂.快速中和肝素及迅速完成動脈瘤的栓塞,對重癥患者行急診腦室外引流術是應對介入術中動脈瘤再破裂的關鍵,有利于病死率降低,預後改善.
목적 탐토파렬성로내동맥류개입술중재파렬적위험인소、응급처리판법급료효.방법분석자2005년지2009년엄동의학원부속의원신경외과수치적236례행개입치료적파렬성로내동맥류환자적림상자료,응용비조건logistic축보회귀방법분석기개입술중재파렬적위험인소,병총결기중발생재파렬적16례환자(6.78%)적처리조시급료효. 결과 파렬성로내동맥류개입술중재파렬적위험인소위:미소동맥류(OR=6.353,95%CI:1.26～31.894,P=0.025),A1、M1원단동맥류(OR=35.449,95%CI:3.053～411.642,P=0.004),동맥죽양경화(OR=5.961,95%CI:1.215～29.260,P=0.028),경도뇌혈관경련(OR=13.048,95%CI:1.220～139.574,P=0.034),중도뇌혈관경련(OR=14.826,95%CI:1.871～117.488,P=0.011).16례환자균채용어정단백쾌속중화간소급신속완성동맥류적전새,기중12례Hunt-HessⅢ급이상자여급진행뇌실외인류술,결과6례사망,1례식물생존상태,9례회복량호. 결론 동맥경화,뇌혈관경련,미소동맥류,A1、M1원단동맥류등인소용역도치파렬성로내동맥류개입술중재파렬.쾌속중화간소급신속완성동맥류적전새,대중증환자행급진뇌실외인류술시응대개입술중동맥류재파렬적관건,유리우병사솔강저,예후개선.
Objective To study the risk factors of intraprocedural re-rupture (IPR) of ruptured intracranial aneurysms, and the emergency management on this event and its efficacy. Methods The clinical data of 236 patients with ruptured intracranial aneurysms, admitted to our hospital from 2005 to 2009 and treated with embolization, were retrospectively analyzed; non-conditional logistic regression analysis was performed to analyze the risk factors of IPR of ruptured intracranial aneurysms. And the emergency management of IPR and its efficacy were concluded in 16 patients with IPR. Results The risk factors of IPR of ruptured intracranial aneurysms included small aneurysms with a diameter smaller than or equaling to 3.0 mm (OR=6.353, 95% CI: 1.266-31.894, P=0.025), aneurysms at distal part of Al and M1 segment of the anterior cerebral artery or middle cerebral artery (OR=35.449, 95% CI:3.053-411.642, P=0.004), atherosclerosis (OR=5.961, 95% CI: 1.215-29.260, P=0.028), mild vasospasm (OR=13.048, 95% CI: 1.220-139.574, P=0.034) and severe vasospasm (OR=14.826, 95% CI:1.871-117.488, P=0.011). Immediate reversal of heparin anticoagulation with protamine sulfate and rapid completion of coiling were performed in 16 patients (6.78%) occurred IPR. Emergent external ventricular drainage was performed in 12 patients having above Hunt-Hess grade Ⅲ:6 patients died; 1 was under persistent vegetative state and 9 fully recovered. Conclusion Small aneurysms, atherosclerosis,cerebral vasospasm and aneurysms at the distal part of Al or M1 segment may easily lead to IPR of ruptured intracranial aneurysms. Rapid completion of coiling combined with immediate reversal of heparin anticoagulation, and emergent external ventricular drainage performed in severe patients are confirmed to be the keys, which can decrease the death rate and improve the prognosis.
