天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (2): 176-179.doi: 10.11958/20160053

• 临床研究 • 上一篇    下一篇

颅内动脉瘤夹闭或介入术后迟发性脑缺血分析

刘朋然， 靳张宁， 蔡新旺， 张振， 高南南， 王者， 杨新宇△   

  1. 天津医科大学总医院神经外科 （邮编 300052）
  • 收稿日期:2016-02-02 修回日期:2016-12-20 出版日期:2017-02-15 发布日期:2017-02-14
  • 通讯作者: △通讯作者 E-mail：yangxinyu@tmu.edu.cn E-mail:13346205959@163.com
  • 作者简介:刘朋然 （1989）， 男， 硕士在读， 主要从事脑血管病研究
  • 基金资助:
    国家自然科学基金资助项目 （81571144）

Analysis of delayed cerebral ischemia after coiling and clipping of intracranial aneurysms

LIU Peng-ran, JIN Zhang-ning, CAI Xin-wang, ZHANG Zhen, GAO Nan-nan, WANG Zhe, YANG Xin-yu△   

  1. Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China
  • Received:2016-02-02 Revised:2016-12-20 Published:2017-02-15 Online:2017-02-14
  • Contact: △Corresponding Author E-mail: yangxinyu@tmu.edu.cn E-mail:13346205959@163.com

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摘要： 目的 比较并分析颅内动脉瘤患者夹闭或介入术后迟发性脑缺血（DCI）的发生情况， 探讨 DCI 发生的危险因素。方法 收集 2011 年 3 月—2014 年 5 月天津医科大学总医院神经外科收治的 CT 血管造影 （CTA） 或全脑血管造影（DSA）检查确诊的颅内动脉瘤性蛛网膜下腔出血（aSAH）患者 236 例， 其中 135 例行开颅夹闭者为夹闭组， 101 例行介入栓塞者为介入组， 比较组间性别、 年龄、 既往史、 术前 GCS 评分、 Hunt-Hess 分级、 Fisher 分级、 WFNS 分级、 动脉瘤位置、 预后等， 采用二分类 Logistic 回归分析探讨 DCI 发生的危险因素。结果 夹闭组中 36 例发生 DCI （26.7%）， 介入组中 11 例发生 DCI （10.9%）， 夹闭组发生率高于介入组 （P＜0.01）。对患者进行 6 个月随访， 夹闭组和介入组预后不良率分别为 17.0%和 25.7%（P＞0.01）， 总体病死率为 11.0%， 前者病死率低于后者（5.9% vs. 17.8%， P＜0.01）。Logistic 回归结果显示， Fisher 分级 3~4 级、 术后肺感染、 开颅手术夹闭是 DCI 发生的独立危险因素（P＜ 0.01）。结论 DCI 是导致动脉瘤术后患者致残率和病死率较高的重要因素， 介入手术较夹闭手术动脉瘤术后 DCI 发生率低， 密切注意 DCI 发生的相关危险因素能在一定程度上改善动脉瘤术后患者的预后。

关键词: 颅内动脉瘤, 脑缺血, 危险因素, 预后, 夹闭, 介入, 迟发型脑缺血

Abstract: Objective To compare and analyze the occurrence of delayed cerebral ischemia（DCI）after coiling and clipping of intracranial aneurysms, and explore the risk factors of DCI. Methods A total of 236 patients with aneurysms diagnosed by CT angiography (CTA) or digital subtraction angiography (DSA) in Department of Neurosurgery, Tianjin Medical University General Hospital were enrolled in this study from March 2011 to May 2014. Patients were divided into clipping group(n=135) and coiling group(n=101). The clinical characteristics were compared between two groups, including gender, age, medical history, GCS score, Hunt-Hess grade, Fisher grade, WFNS grade, aneurysm location, prognosis and incidence of DCI. Risk factors for DCI were investigated by Logistic regression analysis. Results DCI was occurred in 36 patients (26.7%) underwent clipping operation while in 11 patients (10.9%) underwent coiling operation. The incidence was significantly higher in clipping group compared with that of coiling group (P <0.01). The patients were followed up for 6 months. The poor prognosis rates were 17.0% and 25.7% in clipping group and coiling group, respectively (P > 0.01). The overall mortality was 11.0% , the former had a lower mortality rate (5.9% vs. 17.8% , P <0.01). According to Logistic regression analysis, Fisher Grade 3- 4, postoperative pulmonary infection and surgical procedure were independent risk factors for DCI (P＜0.01). Conclusion DCI is one of the most significant factors for high fatality and morbidity of postoperative aneurysm patients. There is a low occurrence of DCI after coiling compared with that of clipping. If we pay more attention to risk factors associated with the DCI, it will improve the prognosis of postoperative aneurysm patients greatly.

Key words: intracranial aneurysm, brain ischemia, risk factors, prognosis, clip, coil, delayed cerebral ischemia