本文選題：顱內(nèi)動脈瘤 + 血管內(nèi)治療��； 參考：《西南醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討顱內(nèi)破裂動脈瘤栓塞術(shù)中再破裂的危險因素、預防處置、術(shù)后管理及預后轉(zhuǎn)歸,為臨床治療策略及圍手術(shù)期管理提供參考。方法:收集并整理西南醫(yī)科大學附屬醫(yī)院神經(jīng)外科2013年8月至2016年8月收治的經(jīng)血管內(nèi)栓塞治療的顱內(nèi)破裂動脈瘤病例資料。采用單因素結(jié)合多因素logistic回歸分析患者一般資料、影像學資料、手術(shù)相關(guān)資料與動脈瘤術(shù)中再破裂的關(guān)系,尋找動脈瘤術(shù)中再破裂的危險因素,并進一步分析影響患者預后的相關(guān)因素。結(jié)果:本組共納入病例215例,其中男性102例(47.4%),女性113例(52.6%),平均年齡55.6±10.0歲。入院Hunt-Hess分級Ⅰ級41例(19.1%),Ⅱ級108例(50.2%),Ⅲ級54例(25.1%),Ⅳ級12例(5.6%)。有高血壓病史者106例(49.3%),有吸煙史者52例(24.2%)。入院CT改良Fisher分級Ⅰ級49例(22.8%),Ⅱ級59例(27.4%),Ⅲ級70例(32.6%),Ⅳ級37例(17.2%)。動脈瘤位于腦動脈前循環(huán)系統(tǒng)者共190例(88.4%),后循環(huán)系統(tǒng)共25例(11.6%)。動脈瘤平均大小5.7±2.6mm。規(guī)則囊狀動脈瘤136例(63.3%),不規(guī)則囊狀動脈瘤43例(20.0%),多分葉或帶子瘤動脈瘤36例(16.7%)。本組病例早期接受手術(shù)者有80例(37.2%),中期接受手術(shù)者有88例(40.9%),延期接受手術(shù)者有47例(21.9%)。其中接受單純彈簧圈栓塞者有108例(50.2%),支架輔助彈簧圈栓塞者有95例(44.2%),球囊輔助彈簧圈栓塞者有12例(5.6%)。術(shù)后即刻造影結(jié)果顯示動脈瘤完全栓塞(RS 1級)175例(81.4%),近全栓塞(RS 2級)32例(14.9%),不全栓塞(RS 3級)8例(3.7%)。本組病例中動脈瘤術(shù)中破裂16例(7.4%)。單因素顯示小型動脈瘤(P=0.004)、多分葉或帶子瘤動脈瘤(P=0.033)、中期手術(shù)(P=0.019)、術(shù)中腦血管痙攣(P=0.016)是動脈瘤術(shù)中破裂的危險因素,多因素分析顯示小型動脈瘤(OR,4.259;95%CI,1.107-16.393;P=0.035)、多分葉或帶子瘤動脈瘤(OR,7.615;95%CI,1.857-31.234;P=0.005)、中期手術(shù)(OR,3.613;95%CI,1.106-11.809;P=0.033)以及術(shù)中腦血管痙攣(OR,5.731;95%CI,1.448-22.683;P=0.013)是動脈瘤術(shù)中破裂的獨立危險因素。研究結(jié)果顯示動脈瘤術(shù)中破裂患者術(shù)后有更高的癥狀性腦血管痙攣發(fā)生率(P=0.021),但動脈瘤術(shù)中破裂不增加患者需手術(shù)干預的腦積水的發(fā)生率。隨訪結(jié)果顯示其總體殘死率達37.5%,顯著高于未發(fā)生術(shù)中破裂患者(P=0.002)。結(jié)論:顱內(nèi)破裂動脈瘤栓塞術(shù)中再破裂發(fā)生率高,殘死率高,嚴重影響患者預后,小型動脈瘤、多分葉或帶子瘤動脈瘤、中期手術(shù)、術(shù)中腦血管痙攣是其發(fā)生的獨立危險因素,動脈瘤術(shù)中破裂患者術(shù)后更易發(fā)生癥狀性腦血管痙攣,有效的術(shù)前評估、預防、及時準確的處置、術(shù)后精細管理等有助于減少此并發(fā)癥的發(fā)生,提高患者預后。
[Abstract]:Objective: to explore the risk factors, prevention and treatment, postoperative management and prognosis of intracranial ruptured aneurysms during embolization, and to provide reference for clinical treatment and perioperative management. Methods: data of intracranial ruptured aneurysms treated by endovascular embolization from August 2013 to August 2016 in Neurosurgery Department affiliated Hospital of Southwest Medical University were collected and analyzed. Univariate and multivariate logistic regression analysis was used to analyze the relationship between the general data, imaging data, surgical data and rerupture during aneurysm operation, and to find out the risk factors of rerupture during aneurysm operation. The factors related to the prognosis of the patients were further analyzed. Results: a total of 215 cases were included in this study, of which 102 cases were male and 113 cases were female, with an average age of 55.6 鹵10.0 years. Hunt-Hess grade 鈪，

本文編號：2032983