本文選題：顱內(nèi)動瘤　切入點：栓塞　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討血管內(nèi)治療顱內(nèi)破裂動脈瘤并發(fā)術(shù)中再破裂的危險因素及對血管內(nèi)治療顱內(nèi)破裂動脈瘤并發(fā)術(shù)中再破裂事件發(fā)生的防治。方法回顧性分析2010年1月至2015年12月我科收治的678例共678枚動脈瘤經(jīng)血管內(nèi)栓塞治療的顱內(nèi)破裂動脈瘤患者臨床資料,采集的數(shù)據(jù)包括:性別、年齡、高血壓史、糖尿病、顱內(nèi)動脈粥樣硬化史、Hunt-Hess分級、動脈瘤的大小、部位、瘤頸特征、血管痙攣情況、治療時間、治療方案、手術(shù)并發(fā)癥(術(shù)中動脈瘤破裂)等。對以上數(shù)據(jù)采用單因素結(jié)合多因素非條件Logistic回歸分析方法,分析手術(shù)并發(fā)癥的危險因素。所有統(tǒng)計資料用SPSSl7.0統(tǒng)計分析系統(tǒng)進行分析,當(dāng)P0.05時差異有統(tǒng)計學(xué)意義。探索血管內(nèi)栓塞治療的顱內(nèi)破裂動脈瘤患者事件的相關(guān)危險因素,并對其中20例發(fā)生術(shù)中再破裂病例的處理方法進行經(jīng)驗總結(jié)。結(jié)果共行栓塞治療678例病人伴678枚破裂動脈瘤,男性318例(47%)、女性360例(53%),平均發(fā)病年齡為56.2+8.6歲。入院時Hunt-Hess分級:Ⅰ-Ⅲ級608例(90%),Ⅳ-Ⅴ級70例(10%)。其中位于前循環(huán)595枚(87.8%)、后循環(huán)83枚(12.2%),微小型動脈瘤97例(14.3%)、小型動脈瘤520例(76.7%)、大型或者巨大型動脈瘤61例(8.9%),寬頸動脈瘤共212例(31.2%)、窄頸動脈瘤466例(68.8%)。顱內(nèi)破裂動脈瘤栓塞術(shù)中再破裂20例,發(fā)病率為2.94%,死亡率25%。12例顱內(nèi)破裂動脈瘤患者由于行硫酸魚精蛋白中和肝素結(jié)合顱內(nèi)動脈瘤快速栓塞而存活,3例患者因行急診腦室外引流術(shù)存活,但是其中有8例患者身體有不同程度傷殘以及7例痊愈�？赡芤鹦g(shù)中再破裂事件的危險因素有:微小動脈瘤(χ2=11.372,P0.05)、術(shù)中出現(xiàn)血管痙攣(χ2=6.119,P0.05)、動脈粥樣硬化(χ2=4.673,P0.05);而性別、年齡、高血壓病史、糖尿病病史、Hunt-Hess分級、瘤頸特征、治療方案及治療時間與術(shù)中發(fā)生動脈瘤破裂事件無明顯關(guān)系(p0.05)。結(jié)論動脈粥樣硬化、血管痙攣及微小動脈瘤是血管內(nèi)治療顱內(nèi)破裂動脈瘤并發(fā)術(shù)中再破裂的危險因素,硫酸魚精蛋白中和肝素結(jié)合顱內(nèi)動脈瘤快速栓塞被證實是最有效的搶救措施。
[Abstract]:Objective to investigate the risk factors of intraoperative rerupture of intracranial ruptured aneurysms and the prevention and treatment of intraoperative rerupture of intracranial ruptured aneurysms.Methods the clinical data of 678 patients with ruptured intracranial aneurysms treated by endovascular embolization from January 2010 to December 2015 were retrospectively analyzed. The data included gender, age, history of hypertension, diabetes mellitus.The history of intracranial atherosclerosis included Hunt-Hess grade, size, location, neck characteristics, vasospasm, treatment time, treatment plan, operative complications (rupture of aneurysm during operation) and so on.Univariate and multivariate non-conditional Logistic regression analysis was used to analyze the risk factors of surgical complications.All statistical data were analyzed by SPSSl7.0 statistical analysis system, when P0.05, the difference was statistically significant.To explore the risk factors of intracranial ruptured aneurysms treated by endovascular embolization, and to summarize the experience of 20 cases of intraoperative rerupture.Results A total of 678 ruptured aneurysms were treated with embolization in 678 patients (318 males and 360 females) with an average age of 56.2 years.On admission, the Hunt-Hess grade was 608 cases of grade 鈪，

本文編號：1711870