75岁以上人群破裂颅内动脉瘤栓塞术后早期预后相关因素分析

doi:10.19854/j.cnki.1008-2425.2022.06.0001

摘要/Abstract

摘要： 目的探讨75岁以上人群破裂颅内动脉瘤栓塞术后,影响患者早期预后的重要相关因素。方法回顾收集从2016年1月到2022年1月在厦门市第三医院神经外科收治的78例颅内动脉瘤患者,所有病例均超过75岁,且均行栓塞治疗的相关临床资料,包括性别、体重、吸烟史、高血压病、糖尿病、高脂血症、房颤、脑血管病史、动脉瘤位置、Hunt-Hess分级、WFNSS分级、CT Fisher分级等;预后结果使用改良Rankin评分(modified Rankin scale,mRS)量表,将患者神经功能预后结局分为结局良好组(mRS评分Ⅰ～Ⅱ级)和结局不良组(mRS评分Ⅲ～V级);将上述临床资料统计学分析,筛选影响患者预后不良的相关危险因素。结果统计学单因素分析,相对于预后良好组,预后不良组的GCS分级、WFNSS分级、Hunt-Hess分级越高,相对预后越差,差异具有统计学意义(P＜0.05)。logistic回归分析显示,GCS分级(OR=1.024,95%CI:0.214～4.914,P=0.976)、WFNSS分级(OR=9.021,95%CI:2.557～31.824,P=0.001)和Hunt-Hess分级(OR=6.848,95%CI:1.435～32.682,P=0.016)是预后的影响因素。ROC曲线分析显示,联合Hunt-Hess分级和WFNSS分级可作为神经功能恢复的重要影响因素(AUC=0.855),取最佳分界点时敏感性89.6%,特异性70.0%。结论对于75岁以上人群破裂颅内动脉瘤介入栓塞近期预后,联合Hunt-Hess分级和WFNSS分级较其他因素更具评估价值,是临床判断患者预后的重要评估手段,具有更科学的临床价值。

关键词: 高龄, 颅内破裂动脉瘤, 蛛网膜下腔出血, 介入栓塞治疗:危险因素, 预后

Abstract: Objective To investigate the important factors affecting the early prognosis of patients over 75 years old after embolization of ruptured intracranial aneurysm.Methods A retrospective collection of 78 patients with intracranial aneurysm who were admitted to the Department of Neurosurgery of Xiamen Third Hospital from January 2016 to January 2022,all cases were over 75 years old,and relevant clinical data of embolization treatment,including gender,Weight,smoking history,hypertension,diabetes,hyperlipidemia,atrial fibrillation,cerebrovascular disease history,aneurysm location,Hunt-Hess classification,WFNSS classification,CT Fisher classification,etc.The prognosis results were divided into a good outcome group (mRS grade I-II) and a poor outcome group (mRS grade III-V) using the modified Rankin scale (mRS) scale.Statistical analysis of clinical data,screening of independent risk factors that affect the poor prognosis of patients.Results Tatistical univariate analysis showed that,compared with the good prognosis group,the higher the GCS grade,WFNSS grade and Hunt-Hess grade of the poor prognosis group,the worse the relative prognosis,and the difference was statistically significant (P＜0.05).Logistic regression analysis showed that GCS classification (OR=1.024,95%CI:0.214~4.914,P=0.976),WFNSS classification (OR=9.021,95%CI:2.557~31.824,P=0.001) and Hunt-Hess classification (OR=6.848,95%CI:1.435~32.682,P=0.016) was a prognostic factor.ROC curve analysis showed that the combination of Hunt-Hess classification and WFNSS classification could be used as an important influencing factor for neurological recovery (AUC=0.855),When taking the best cut-off point,the sensitivity was 89.6% and the specificity was 70.0%.Conclusion For the short-term prognosis of ruptured intracranial aneurysm interventional embolization in people over 75 years old,the combination of Hunt-Hess classification and WFNSS classification is more valuable than other factors.

Key words: Advanced age, Ruptured intracranial aneurysm, Subarachnoid hemorrhage, Interventional embolization:Risk factors, Prognosis

中图分类号:

R732.2⁺1

陈锋龙, 陈金龙, 张弋. 75岁以上人群破裂颅内动脉瘤栓塞术后早期预后相关因素分析[J]. 立体定向和功能性神经外科杂志, 2022, 35(6): 321-325.

Chen Fenglong, Chen Jinjong, Zhang Yi. Analysis of early prognostic factors after embolization of ruptured intracranial aneurysm in people over 75 years old.[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2022, 35(6): 321-325.

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