CAJ | 학술논문

目的对前循环动脉动脉瘤夹闭术中动脉瘤破裂(intraoperative aneurysm rupture,IAR)后影响手术效果的可能因素进行分析.方法对2007年5月至2012年3月间连续入选的135例接受显微动脉瘤夹闭术的患者(148个动脉瘤)临床资料进行回顾性分析,对手术时机、术前Hunt-Hess评级、高血压病史、动脉瘤位置、术中临时阻断夹的应用及内镜辅助观察等可能影响预后的因素进行单因素分析,并对有统计学意义的因素进行Logistic回归多因素分析.结果在135例患者的148个动脉瘤夹闭术中,有31例患者的30个动脉瘤发生术中破裂(占动脉瘤的22.22％,占患者的20.95％),最终对所有接受治疗患者在术后1、3及6个月进行随访得到格拉斯哥预后评分:5分94例,4分23例,3分9例,2分2例,1分8例.统计学分析结果显示,手术时机的选择(OR=0.063,P=0.019)、术前Hunt-Hess评级(OR=12.667,P=0.031)以及是否有高血压病(OR=0.143,P=0.045)都是影响IAR患者预后的因素,而动脉瘤的位置、术中是否使用临时阻断夹以及术中是否使用辅助观察夹闭效果等不是IAR患者手术预后的影响因素.IAR患者的预后受到多种因素的综合影响.结论手术时机、术前Hunt-Hess评级以及高血压病史都是影响IAR患者预后的因素,动脉瘤的位置、临时阻断夹的使用以及术中是否使用辅助观察等不是IAR患者手术预后的影响因素.IAR患者的预后受到多种因素的综合影响.
목적 대전순배동맥동맥류협폐술중동맥류파렬(intraoperative aneurysm rupture,IAR)후영향수술효과적가능인소진행분석.방법 대2007년5월지2012년3월간련속입선적135례접수현미동맥류협폐술적환자(148개동맥류)림상자료진행회고성분석,대수술시궤、술전Hunt-Hess평급、고혈압병사、동맥류위치、술중림시조단협적응용급내경보조관찰등가능영향예후적인소진행단인소분석,병대유통계학의의적인소진행Logistic회귀다인소분석.결과 재135례환자적148개동맥류협폐술중,유31례환자적30개동맥류발생술중파렬(점동맥류적22.22％,점환자적20.95％),최종대소유접수치료환자재술후1、3급6개월진행수방득도격랍사가예후평분:5분94례,4분23례,3분9례,2분2례,1분8례.통계학분석결과현시,수술시궤적선택(OR=0.063,P=0.019)、술전Hunt-Hess평급(OR=12.667,P=0.031)이급시부유고혈압병(OR=0.143,P=0.045)도시영향IAR환자예후적인소,이동맥류적위치、술중시부사용림시조단협이급술중시부사용보조관찰협폐효과등불시IAR환자수술예후적영향인소.IAR환자적예후수도다충인소적종합영향.결론 수술시궤、술전Hunt-Hess평급이급고혈압병사도시영향IAR환자예후적인소,동맥류적위치、림시조단협적사용이급술중시부사용보조관찰등불시IAR환자수술예후적영향인소.IAR환자적예후수도다충인소적종합영향.
Objective To investigate the practicable factors which have an influence on prognosis of anterior circulating intraoperative aneurysm rupture (IAR) in the clipping operation.Methods The clinical data of 135 patients with 148 aneurysms,treated with micro-neurosurgical techniques for clipping intracranial aneurysm from May 2007 to March 2012,were retrospectively analyzed.Statistics analysis was performed to analyze the possible factors,such as operation time,pre-operative Hunt-Hess Scale,history of hypertension,position of aneurysm,application of temporary clip and intraoperative endoscopic assisted observation.Results Thirty-one aneurysms of 30 patients ruptured (22.22％ of aneurysms and 20.95％ of patients) during the operations.The outcome of patients were estimated by Glasgow Outcome Scale (GOS) by following up at 1,3,and 6 months after surgery:94 patients were 5,23 patients were 4,9 patients were 3,2 patients were 2 and 8 patients were 1.Statistic analysis revealed that operation time(OR =0.063,P =0.019),pre-operative Hunt-Hess Scale (OR =12.667,P =0.031) and history of hypertension (OR =0.143,P =0.045)are the factors that influenced the prognosis of the operation with IAR,whereas the position,application of temporary clip and intraoperative endoscopic assisted observation were not associated.Conclusions Operation time,pre-operative Hunt-Hess Scale and history of hypertension are the factors that influenced the prognosis of operation with IAR,whereas application of temporary clip and intraoperative endoscopic assisted observation are not associated.The prognosis of anterior circulating intraoperative aneurysm rupture in the clipping operation was influenced by the combination of various factor.