本文選題：前循環(huán)動(dòng)脈瘤　切入點(diǎn)：顯微外科　出處：《鄭州大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過對(duì)影響顱內(nèi)前循環(huán)動(dòng)脈瘤夾閉術(shù)后療效的多種相關(guān)因素進(jìn)行綜合和分析,發(fā)現(xiàn)具有統(tǒng)計(jì)學(xué)意義的指標(biāo),以期對(duì)前循環(huán)動(dòng)脈瘤夾閉術(shù)起指導(dǎo)作用,最終幫助患者獲得最好的手術(shù)療效。方法回顧性總結(jié)鄭州大學(xué)第一附屬醫(yī)院神經(jīng)外科自2012年01月01日至2013年12月31日接受顯微動(dòng)脈瘤夾閉術(shù)的資料完整的98例顱內(nèi)前循環(huán)動(dòng)脈瘤患者的臨床資料。隨訪時(shí)間為患者出院后6—12個(gè)月,按照患者的性別分布情況、年齡差異、是否具有高血壓史、吸煙史、患者的Fisher和Hunt-Hess分級(jí)情況、患者的動(dòng)脈瘤數(shù)量情況、具體位置、具體大小以及手術(shù)情況(手術(shù)時(shí)機(jī)、術(shù)中動(dòng)脈瘤破裂、術(shù)中臨時(shí)阻斷)等相關(guān)因素進(jìn)行分組,并比較各組患者的格拉斯哥預(yù)后量表(Glasgow Outcome Scale,GOS)評(píng)分結(jié)果。采用統(tǒng)計(jì)學(xué)方法驗(yàn)證各種因素對(duì)于臨床預(yù)后的影響作用效果。結(jié)果單因素分析結(jié)果表明:①Hunt-Hess分級(jí)不同患者的GOS評(píng)分結(jié)果差異顯著,且均有統(tǒng)計(jì)學(xué)意義(P0.05);②年齡不同患者的GOS評(píng)分結(jié)果差異顯著,且均有統(tǒng)計(jì)學(xué)意義(P0.05);③有無高血壓病史的患者的GOS評(píng)分結(jié)果差異不顯著,且無統(tǒng)計(jì)學(xué)意義(P0.05);④有無吸煙史的患者的GOS評(píng)分結(jié)果差異不顯著,且無統(tǒng)計(jì)學(xué)意義(P0.05);⑤數(shù)量、部位和瘤囊最大徑不同患者的GOS評(píng)分結(jié)果差異不顯著,且無統(tǒng)計(jì)學(xué)意義(P0.05);⑥不同手術(shù)時(shí)機(jī)患者的GOS評(píng)分結(jié)果差異不顯著,且無統(tǒng)計(jì)學(xué)意義(P0.05);⑦術(shù)中有無動(dòng)脈瘤破裂的患者的GOS評(píng)分結(jié)果差異不顯著,且無統(tǒng)計(jì)學(xué)意義(P0.05);⑧術(shù)中是否曾行臨時(shí)阻斷的患者的GOS評(píng)分結(jié)果差異不顯著,且無統(tǒng)計(jì)學(xué)意義(P0.05);⑨性別不同患者的GOS評(píng)分結(jié)果差異不顯著,且無統(tǒng)計(jì)學(xué)意義(P0.05);⑩患者的不同F(xiàn)isher分級(jí)與術(shù)后療效(GOS)的關(guān)系采用兩樣本比較的秩和檢驗(yàn)。結(jié)果顯示P0.01,有明顯統(tǒng)計(jì)學(xué)差異。這說明術(shù)前頭顱CT顯示單純蛛網(wǎng)膜下腔出血(subarachnoid hemorrhage,SAH)的患者比有腦室內(nèi)出血和/或腦實(shí)質(zhì)內(nèi)血腫的患者預(yù)后明顯要好。結(jié)論Hunt-Hess分級(jí)與Fisher分級(jí)情況,這兩者是影響患者行動(dòng)脈瘤夾閉術(shù)后療效的危險(xiǎn)因素。而患者的性別、年齡、高血壓史、吸煙史、動(dòng)脈瘤數(shù)量、動(dòng)脈瘤部位、動(dòng)脈瘤大小、手術(shù)時(shí)機(jī)、術(shù)中臨時(shí)阻斷和術(shù)中動(dòng)脈瘤破裂等都不是影響患者預(yù)后的危險(xiǎn)因素。
[Abstract]:Objective to find out statistically significant indexes by synthesizing and analyzing various related factors that influence the curative effect of anterior circulation aneurysm clipping in order to guide the operation of anterior circulation aneurysm clipping. Methods 98 patients received microaneurysm clipping from January 1st 2012 to December 31st 2013 were reviewed retrospectively in neurosurgery department of the first affiliated hospital of Zhengzhou University. Clinical data of patients with internal anterior circulation aneurysms. According to gender distribution, age difference, history of hypertension, history of smoking, Fisher and Hunt-Hess grading, number of aneurysms, location, size, and operation (timing of operation), Related factors such as rupture of aneurysm during operation and temporary occlusion during operation were divided into groups. The results of Glasgow Outcome scale score were compared. Statistical methods were used to verify the effect of various factors on the clinical prognosis. Results the univariate analysis showed that: 1 Hunt-Hess grade of patients with different grades of patients. There were significant differences in GOS scores, There were significant differences in GOS scores between patients with different ages and with or without history of hypertension, and there was no significant difference in GOS scores between patients with different ages and with or without history of hypertension, and there was no significant difference in GOS scores between patients with different ages and with or without history of hypertension, and there was no significant difference in GOS scores between patients with or without history of hypertension. There was no significant difference in the GOS score between the patients with or without smoking history, and there was no significant difference in the number of P0.05 and the GOS score between the patients with different location and the largest diameter of the tumor sac, and there was no significant difference in the GOS score between the patients with different sites and the largest diameter of the tumor sac. There was no significant difference in GOS score between patients with different operative time and no significant difference in GOS score between patients with or without rupture of aneurysm. There was no significant difference in the GOS score between the patients who had undergone temporary occlusion or not, and there was no significant difference in the GOS score between the patients with different genders and the patients with no significant difference in P0.05 or P0.05, and there was no significant difference in the GOS scores between the two groups, and there was no significant difference in the GOS scores between the two groups. There was no statistical significance in the relationship between Fisher grade and postoperative curative effect in patients with P0.05 or 10. The rank sum test was used to compare the two samples. The results showed that there was a significant difference in P0.01. this indicated that the preoperative cranial CT showed the simple subarachnoid cavity exophthalmos. The prognosis of patients with subarachnoid hemorrhage was significantly better than that with intraventricular hemorrhage and / or intracerebral parenchyma hematoma. Conclusion the Hunt-Hess and Fisher grades are better than those with intraventricular hemorrhage and / or intracerebral parenchyma hematoma. These are the risk factors that influence the outcome of aneurysm clipping. Gender, age, history of hypertension, history of smoking, number of aneurysms, location of aneurysm, size of aneurysm, timing of operation, and the patient's sex, age, history of hypertension, history of smoking, number of aneurysms, size of aneurysm, timing of operation. Temporary occlusion during operation and rupture of aneurysm during operation were not risk factors for prognosis.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651.12

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 楊立惠;文波;朱曉燕;;40例顱內(nèi)多發(fā)動(dòng)脈瘤手術(shù)配合體會(huì)[J];華西醫(yī)學(xué);2009年02期

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本文編號(hào)：1617826