本文選題：大腦中動(dòng)脈瘤　切入點(diǎn)：手術(shù)預(yù)后　出處：《青島大學(xué)》2017年碩士論文

【摘要】：目的:探討影響大腦中動(dòng)脈瘤手術(shù)預(yù)后的多種因素,為提高大腦中動(dòng)脈瘤療效提供理論參考。方法:回顧性分析青島大學(xué)附屬醫(yī)院自1996-2015年開(kāi)顱手術(shù)治療的260例大腦中動(dòng)脈瘤患者,總結(jié)臨床資料和預(yù)后情況。預(yù)后的評(píng)定指標(biāo)以GOS評(píng)分為依據(jù),選取可能存在影響手術(shù)療效相關(guān)的13項(xiàng)因素,分析對(duì)其預(yù)后的影響。把13項(xiàng)觀察指標(biāo)性別,年齡,蛛網(wǎng)膜下腔出血次數(shù),Hunt-Hess分級(jí),術(shù)前神志,動(dòng)脈瘤的側(cè)別,動(dòng)脈瘤的大小,動(dòng)脈瘤的發(fā)出部位,動(dòng)脈瘤的指向,手術(shù)時(shí)機(jī),術(shù)中有無(wú)破裂,CT示SAH特點(diǎn),術(shù)后并發(fā)癥作為自變量,定義療效為因變量,與療效相關(guān)的各項(xiàng)因素定性并賦值。第一步,分析各個(gè)單因素與預(yù)后的關(guān)系,即定性的自變量是否對(duì)預(yù)后的結(jié)果有影響,本文采用非參數(shù)統(tǒng)計(jì)多樣本秩和檢驗(yàn)探究定性自變量對(duì)預(yù)后是否影響,若秩和檢驗(yàn)結(jié)果P0.05,表明通過(guò)檢驗(yàn),即有統(tǒng)計(jì)學(xué)意義。反之,不通過(guò)檢驗(yàn)。第二步,建立二元Logistic回歸模型,在第一步的基礎(chǔ)上選擇通過(guò)檢驗(yàn)的自變量,且將預(yù)后的四種情況分為兩類,第一級(jí)作為第一類,表示預(yù)后效果良好,即治愈情況表示預(yù)后良好,第二、三、四級(jí)作為第二類,表示預(yù)后效果較差,即治療情況認(rèn)為預(yù)后不良,在此基礎(chǔ)上做二元Logistic回歸模型。運(yùn)用統(tǒng)計(jì)學(xué)軟件SPSS17.0進(jìn)行二元Logistic回歸分析計(jì)算檢驗(yàn),分析并尋找對(duì)手術(shù)預(yù)后有明顯統(tǒng)計(jì)學(xué)意義的因素。結(jié)果:統(tǒng)計(jì)學(xué)單因素分析顯示患者的蛛網(wǎng)膜下腔出血的次數(shù)、Hunt-Hess分級(jí)、術(shù)前的神志情況、CT示SAH特點(diǎn)、術(shù)后并發(fā)癥具有對(duì)手術(shù)治療預(yù)后影響差異,具有顯著的統(tǒng)計(jì)學(xué)意義,是影響預(yù)后的危險(xiǎn)因素。再用二元Logistic逐步回歸法篩選變量,結(jié)果表明Hunt-Hess分級(jí)、術(shù)后并發(fā)癥是影響大腦中動(dòng)脈瘤患者預(yù)后的顯著危險(xiǎn)性因素,即影響效果顯著。性別,年齡,動(dòng)脈瘤的側(cè)別,動(dòng)脈瘤的大小,動(dòng)脈瘤的發(fā)出部位,動(dòng)脈瘤的指向,手術(shù)時(shí)機(jī),術(shù)中有無(wú)破裂等因素與行大腦中動(dòng)脈瘤夾閉術(shù)的患者療效并無(wú)統(tǒng)計(jì)學(xué)關(guān)系。結(jié)論:大腦中動(dòng)脈瘤患者術(shù)后是否出現(xiàn)相關(guān)并發(fā)癥與Hunt-Hess分級(jí)是影響手術(shù)預(yù)后的顯著危險(xiǎn)因素,通過(guò)對(duì)患者術(shù)后是否出現(xiàn)相關(guān)并發(fā)癥、蛛網(wǎng)膜下腔出血的次數(shù)、Hunt-Hess分級(jí)、術(shù)前的神志情況、CT示SAH特點(diǎn)等大腦中動(dòng)脈瘤的危險(xiǎn)性因素的全面系統(tǒng)的分析,可以基本評(píng)估大腦中動(dòng)脈瘤的預(yù)后情況,提高預(yù)測(cè)預(yù)后的準(zhǔn)確性,尋找改善預(yù)后的突破點(diǎn),進(jìn)而下一步避免和控制危險(xiǎn)性因素,改善治療手段并采取措施,為后續(xù)更好的治療提供參考,以改善臨床預(yù)后。
[Abstract]:Objective: to investigate the factors influencing the prognosis of middle cerebral aneurysm. Methods: 260 cases of middle cerebral aneurysm treated by craniotomy in Qingdao University from 1996 to 2015 were analyzed retrospectively. The clinical data and prognosis were summarized. The prognostic evaluation indexes were based on the GOS score, and 13 factors related to the outcome of the operation were selected, and the influence on the prognosis was analyzed. The number of subarachnoid hemorrhage was Hunt-Hess grade, preoperative consciousness, the side of aneurysm, the size of aneurysm, the location of aneurysm, the direction of aneurysm, the timing of operation, the CT features of intraoperative rupture or not, and postoperative complications as independent variables. The first step is to analyze the relationship between each single factor and the prognosis, that is, whether the qualitative independent variable has an effect on the outcome of the prognosis. In this paper, the non-parametric statistical multi-sample rank sum test is used to investigate whether qualitative independent variables affect the prognosis. If the result of rank sum test is P0.05, it shows that there is statistical significance through the test. Conversely, the non-pass test is not passed. In the second step, a binary Logistic regression model is established. On the basis of the first step, the independent variables that have passed the test are selected, and the four conditions of prognosis are divided into two categories. The first stage, as the first category, indicates that the prognosis is good, that is, the cure condition indicates a good prognosis, and the second, third, and fourth levels are the second category. The results show that the prognosis is poor, that is, the treatment considers the prognosis to be poor, on the basis of which the binary Logistic regression model is made. The statistical software SPSS17.0 is used to calculate and test the binary Logistic regression analysis. Results: single factor analysis showed the frequency of subarachnoid hemorrhage in patients and the Hunt-Hess grade. The preoperative mental state and CT showed SAH features. Postoperative complications have significant difference in the prognosis of surgical treatment, and are significant risk factors for prognosis. Binary Logistic stepwise regression method was used to screen the variables, the results showed that the Hunt-Hess grade. Postoperative complications are significant risk factors affecting the prognosis of patients with middle cerebral artery aneurysms, i.e., the effects are significant: sex, age, the side of the aneurysm, the size of the aneurysm, the location of the aneurysm, the location of the aneurysm, the direction of the aneurysm, the timing of the operation. There was no significant correlation between the outcome of middle cerebral aneurysm clipping and whether there were related complications or not in patients with middle cerebral artery aneurysm. Conclusion: Hunt-Hess grade and postoperative complications are significant risk factors for prognosis of patients with middle cerebral artery aneurysm. The risk factors of middle cerebral aneurysm, such as the complications, the frequency of subarachnoid hemorrhage, the Hunt-Hess grade, the preoperative mental state and the characteristics of SAH, were analyzed systematically. It can evaluate the prognosis of middle cerebral aneurysm, improve the accuracy of predicting prognosis, find a breakthrough point to improve the prognosis, and then avoid and control the risk factors, improve the treatment methods and take measures. To provide a reference for further better treatment to improve the clinical prognosis.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.12

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