CAJ | 학술논문

目的探讨颅内前循环动脉瘤夹闭术前预见术中动脉瘤破裂的有效预见因素.方法回顾性分析接受颅内动脉瘤夹闭术的96例患者的临床资料,对可能的预见因素如高血压病史、术前Hunt-Hess评级、动脉瘤位置、动脉瘤子阜、动脉瘤顶颈比、动脉瘤指向及手术时机等进行单因素分析和Logistic回归分析.结果在96例115个动脉瘤夹闭术中,有21例(21.9％,21/96)患者的21个(18.3％,21/115)动脉瘤发生术中破裂,2例死亡,余94例患者术后6个月Rank评分0分66例,2分10例,3分6例,4分4例,5分6例,6分2例.统计学分析结果显示,高血压病史(P=0.037)、术前Hunt-Hess评级(P=0.040)、动脉瘤指向(P=0.009)、动脉瘤子阜(P=0.010)、手术时机(P=0.001)以及动脉瘤顶颈比(P=0.029)都是术中动脉瘤破裂发生的预见因素,动脉瘤位置(P=0.198)不是预见因素.结论既往有高血压病史,术前Hunt-Hess评级为重症,动脉瘤指向术者,动脉瘤瘤体有子阜,早期手术以及动脉瘤顶颈比在1.78～2.89的动脉瘤在术中较易发生破裂,术中破裂是各种因素综合作用的结果.
목적 탐토로내전순배동맥류협폐술전예견술중동맥류파렬적유효예견인소.방법 회고성분석접수로내동맥류협폐술적96례환자적림상자료,대가능적예견인소여고혈압병사、술전Hunt-Hess평급、동맥류위치、동맥류자부、동맥류정경비、동맥류지향급수술시궤등진행단인소분석화Logistic회귀분석.결과 재96례115개동맥류협폐술중,유21례(21.9％,21/96)환자적21개(18.3％,21/115)동맥류발생술중파렬,2례사망,여94례환자술후6개월Rank평분0분66례,2분10례,3분6례,4분4례,5분6례,6분2례.통계학분석결과현시,고혈압병사(P=0.037)、술전Hunt-Hess평급(P=0.040)、동맥류지향(P=0.009)、동맥류자부(P=0.010)、수술시궤(P=0.001)이급동맥류정경비(P=0.029)도시술중동맥류파렬발생적예견인소,동맥류위치(P=0.198)불시예견인소.결론 기왕유고혈압병사,술전Hunt-Hess평급위중증,동맥류지향술자,동맥류류체유자부,조기수술이급동맥류정경비재1.78～2.89적동맥류재술중교역발생파렬,술중파렬시각충인소종합작용적결과.
Objective To discuss the predictable factors for the occurrence of intraoperative aneurysm rupture(IAR) of anterior circulation aneurysm treated by clipping.Methods The clinical data of 96 patients with 115 aneurysms treated by clipping were retrospectively analyzed.The univariate analysis and Logistic regression analysis was performed for the risk factors of IAR such as history of hypertension,pre-operative Hunt-Hess scale,aneurysm location,aneurysm sac,aneurysm dome/neck ratio,aneurysm direction,and operation time.Results Twenty-one patients occurred IAR [18.3 ％ (21/115) of aneurysms,21.9％ (21/96) of patients] during the operation,2 patients died and 94 patients were estimated by Rank scale:0 score was for 66 patients,2 scores was for 10 patients,3 scores was for 6 patients,4 scores was for 4 patients,5 scores was for 6 patients and 6 scores was for 2 patients at 6 months after surgery.Statistic analysis revealed that history of hypertension (P =0.037),pre-operative Hunt-Hess scale (P =0.040),aneurysm direction (P =0.009),aneurysm sac (P =0.010),operation time (P =0.001) and aneurysm dome/neck ratio (P =0.029) were the predictable factors for the occurrence of IAR,while aneurysm location was not included (P =0.198).Conclusion The history of hypertension,pre-operative Hunt-Hess scale,aneurysm direction,aneurysm sac,operation time and aneurysm dome/neck ratio 1.78-2.89 are the predictable factors for the occurrence of IAR and the combination of various factors lead to the occurrence of IAR.