颅内破裂动脉瘤夹闭术后并发急性缺血性卒中危险因素分析

doi:10.3969/j.issn.1672-6731.2020.09.012

摘要/Abstract

摘要：

目的探讨颅内破裂动脉瘤夹闭术后并发急性缺血性卒中的相关危险因素。方法以2013年1月至2018年1月施行颅内动脉瘤夹闭术辅助脑室外引流术或去骨瓣减压术的颅内破裂动脉瘤患者为观察对象，单因素和多因素后退法Logistic回归分析筛查术后并发急性缺血性卒中的相关危险因素。结果共267例患者中62例（23.22%）颅内动脉瘤夹闭术后并发急性缺血性卒中；单因素与多因素Logistic回归分析一致提示，合并高血压（OR=1.695，95% CI：1.247~2.631；P=0.006）、入院时血糖升高（OR=4.206，95% CI：2.771~6.284；P=0.000）、术前Hunt-Hess分级≥ Ⅲ级（OR=1.443，95% CI：1.205~1.872；P=0.017）、合并脑室出血（OR=1.947，95% CI：1.465~2.973；P=0.001）和急性脑积水（OR=3.221，95% CI：2.218~4.960；P=0.000）是颅内动脉瘤夹闭术后并发急性缺血性卒中的危险因素。。结论合并高血压、入院时血糖升高、术前Hunt-Hess分级≥ Ⅲ级、合并脑室出血和急性脑积水的颅内破裂动脉瘤患者夹闭术后易发生急性缺血性卒中。

关键词: 颅内动脉瘤, 动脉瘤, 破裂, 手术后并发症, 卒中, 脑缺血, 危险因素, Logistic模型

Abstract:

Objective To analyze risk factors related to acute ischemic stroke after intracranial aneurysm clipping. Methods From January 2013 to January 2018, 267 cases of intracranial ruptured aneurysm in our hospital were collected retrospectively. All patients were given intracranial aneurysm clipping, ventricular drainage and decompression with bone flap vemova. Univariate and multivariate backward Logistic regression analysis were used to analyze the risk factors for ischemic stroke after intracranial aneurysm clipping. Results There were 62 patients (23.22%) with acute ischemic stroke after intracranial aneurysm clipping. Logistic regression analysis showed that hypertension (OR=1.695, 95% CI:1.247-2.631; P=0.006), blood glucose (OR=4.206, 95%CI:2.771-6.284; P=0.000), Hunt-Hess grade ≥ Ⅲ (OR=1.443, 95%CI:1.205-1.872; P=0.017), ventricular hemorrhage (OR=1.947, 95%CI:1.465-2.973; P=0.001) and acute hydrocephalus (OR=3.221, 95%CI:2.218-4.960; P=0.000) were risk factors for acute ischemic stroke after intracranial aneurysm clipping. Conclusions The hypertension, blood glucose increased on admission, preoperative Hunt-Hess grade ≥ Ⅲ, ventricular hemorrhage and acute hydrocephalus were risk factors for acute ischemic stroke after clipping of intracranial aneurysm rupture.

Key words: Intracranial aneurysm, Aneurysm, ruptured, Postoperative complications, Stroke, Brain ischemia, Risk factors, Logistic models

赖湘, 张文波, 叶敏, 梁明礼, 刘晓平, 张光宇, 叶俊华. 颅内破裂动脉瘤夹闭术后并发急性缺血性卒中危险因素分析[J]. 中国现代神经疾病杂志, 2020, 20(9): 827-831.

LAI Xiang, ZHANG Wen-bo, YE Min, LIANG Ming-li, LIU Xiao-ping, ZHANG Guang-yu, YE Jun-hua. Analysis of related risk factors of acute ischemic stroke after surgical clipping of ruptured intracranial aneurysms[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(9): 827-831.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I9/827

参考文献

[1] Li MH, Chen SW, Li YD, Chen YC, Cheng YS, Hu DJ, Tan HQ, Wu Q, Wang W, Sun ZK, Wei XE, Zhang JY, Qiao RH, Zong WH, Zhang Y, Lou W, Chen ZY, Zhu Y, Peng DR, Ding SX, Xu XF, Hou XH, Jia WP. Prevalence of unruptured cerebral aneurysms in Chinese adults aged 35 to 75 years:a cross-sectional study. Ann Intern Med, 2013, 159:514-521.
[2] Ding YB, Yu RT, Liu HQ, Gu J, Li X. Diagnostic value of three-dimensional computed tomographic angiography in intracranial aneurysm[J]. Lin Chuang Shen Jing Wai Ke Za Zhi, 2017, 14:378-381.[丁允波, 于如同, 刘厚强, 谷佳, 李祥. 三维CT血管成像对颅内动脉瘤的临床诊疗价值[J]. 临床神经外科杂志, 2017, 14:378-381.]
[3] Xu F. Strategies and techniques of intracranial aneurysm clipping[J]. Lin Chuang Shen Jing Wai Ke Za Zhi, 2017, 14:161-162.[徐锋. 颅内动脉瘤手术夹闭的策略和技巧[]J. 临床神经外科杂志, 2017, 14:161-162.]
[4] Li H, He YK, Bai WX, Xu B, Li TX, Li L. Safety and mid-term outcome of Pipeline embolization device in the treatment of complex intracranial aneurysms[J]. Zhonghua Shen Jing Wai Ke Za Zhi, 2018, 34:442-446.[李航, 贺迎坤, 白卫星, 许斌, 李天晓, 李立. Pipeline血流导向装置治疗复杂颅内动脉瘤的安全性及中期疗效[J]. 中华神经外科杂志, 2018, 34:442-446.]
[5] Dumont AS, Crowley RW, Monteith SJ, Ilodigwe D, Kassell NF, Mayer S, Ruefenacht D, Weidauer S, Pasqualin A, Macdonald RL. Endovascular treatment or neurosurgical clipping of ruptured intracranial aneurysms:effect on angiographic vasospasm, delayed ischemic neurological deficit, cerebral infarction, and clinical outcome[J]. Stroke, 2010, 41:2519-2524.
[6] Liu ZY, Li J, Ma L, Li H, Liu Y, He M, Xu JG. Diagnosis and treatment of ruptured intracranial aneurysm in infants (report of 6 cases)[J]. Zhonghua Shen Jing Wai Ke Za Zhi, 2018, 34:437-441.[刘志勇, 李进, 马潞, 李浩, 刘翼, 贺民, 徐建国. 婴儿颅内破裂动脉瘤的诊断和治疗(附六例报告)[J]. 中华神经外科杂志, 2018, 34:437-441.]
[7] Chen XH, Xu GF, Bai XB, Xie WF. Correlation between atherosclerosis and rupture of intracranial aneurysms[J]. Shen Jing Sun Shang Yu Gong Neng Chong Jian, 2018, 13:120-121.[陈先海,徐高峰, 白晓斌, 谢万福. 动脉粥样硬化与颅内动脉瘤破裂的相关性研究[J]. 神经损伤与功能重建, 2018, 13:120-121.]
[8] Zhang C, Liu XY, Wang CB. Risk assessment of chronic subdural hematoma after surgical clipping of intracranial aneurysms[J]. Zhongguo Nao Xue Guan Bing Za Zhi, 2018, 15:63-67.[张超, 刘小印, 王传宝. 手术夹闭颅内动脉瘤术后发生慢性硬膜下血肿的风险评估[J]. 中国脑血管病杂志, 2018, 15:63-67.]
[9] Li H, Huang ZJ, Wen H, Qi LJ, Liu GJ, Chai WN, Xu D, Yang XM, Sun XC. Clinical value of intracranial pressure wave parameters in patients after intracranial aneurysm clipping[J]. Di San Jun Yi Da Xue Xue Bao, 2018, 40:631-635.[李辉, 黄志坚, 文毫, 漆凌骏, 刘国静, 柴伟娜, 徐丹, 杨小敏, 孙晓川. 颅内动脉瘤夹闭术后颅内压波形参数的临床价值[J]. 第三军医大学学报, 2018, 40:631-635.]
[10] Zhao L, Yang M, Dong PF, Li LF, Wang LQ. Embolization of intracranial aneurysms with "equal coils technique"[J]. Nao Yu Shen Jing Ji Bing Za Zhi, 2018, 26:216-220.[赵林, 杨明, 董鹏飞, 李林芳, 王立群. 等圈技术栓塞颅内动脉瘤[J]. 脑与神经疾病杂志, 2018, 26:216-220.]
[11] Hu LS, Wang WH, Lin H, Yu YG, Li J, Huang W, Lin JM, Luo F. Secondary massive cerebral infarction after removal of acute epidural hematoma:multivariate Logistic regression analysis of risk factors[J]. Zhonghua Shen Jing Wai Ke Ji Bing Yan Jiu Za Zhi, 2014, 13:31-35.[胡连水, 王文浩, 林洪, 郁毅刚, 李君, 黄巍, 林俊明, 罗飞. 急性硬膜外血肿清除术后继发大面积脑梗塞的多因素Logistic成因分析[J]. 中华神经外科疾病研究杂志, 2014, 13:31-35.]
[12] Gao YF, Chang T, Yang YL, Li LH. Effect of decompressive surgery for the treatment of massive cerebral infarction and analysis of the relative factors[J]. Zhonghua Shen Jing Wai Ke Ji Bing Yan Jiu Za Zhi, 2015, 14:338-341.[高亚飞, 常涛, 杨彦龙, 李立宏. 大骨瓣减压术治疗大面积脑梗塞的疗效及相关因素分析[J]. 中华神经外科疾病研究杂志, 2015, 14:338-341.]
[13] Gong ZY, Jiang SL, Li BJ, Ren CL,Wang MY, Wang Y, Chen TT, Zhang T, Gao CG. Early results of left atrial appendage closure in cerebral ischemic stroke reduction in patients with mitral valve replacement[J]. Zhonghua Wai Ke Za Zhi, 2014, 52:934-938.[龚志云, 姜胜利, 李伯君, 任崇雷, 王明岩, 王瑶,陈婷婷, 张涛, 高长青. 同期左心耳闭合预防二尖瓣置换术后缺血性脑卒中的早期结果[J]. 中华外科杂志, 2014, 52:934-938.]
[14] Krueger EM, Trombly R, Guglielmi G, Farhat H. Delayed rupture of a cortical traumatic intracranial aneurysm[J]. Cureus, 2018, 10:e3643.
[15] Howard BM, Frerich JM, Madaelil TP, Dion JE, Tong FC, Cawley CM, Grossberg JA. ‘Plug and pipe’ strategy for treatment of ruptured intracranial aneurysms[J]. J Neurointervsurg, 2019, 11:43-48.
[16] Munakomi S. Letter to the editor:temporary occlusion during clipping of ruptured intracranial aneurysms[J]. J Neurosurg, 2018, 129:1662.
[17] Beydoun HN, Beydoun MA, Zonderman AB, Eid SM. Racial and ethnic disparities in treatment outcomes of patients with ruptured or unruptured intracranial aneurysms[J]. J Racial Ethnic Health Disparities, 2019, 6:345-355.
[18] Yokoya S, Hino A, Goto Y, Oka H. Pros and cons of tentative clipping in intracranial aneurysm surgery:review of 867 direct clippings in single institution[J]. World Neurosurg, 2018, 118:e185-187.
[19] Frch R, Pasqualin A, Pnana G, Chioffi F, Bricolo A. Temporary artery occlusion in the repair of ruptured intracranial aneurysms:analysis of risk factors for stroke[J]. J Neurosurg, 2002, 97:836-842.
[20] van Asch CJ, van der Schaaf IC, Rinkel GJ. Acute hydrocephalus and cerebral perfusion after aneurismal subarachnoid hemorrhage[J]. AJNR Am J Neuroradiol, 2010, 31:67-70.

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2 颅内破裂动脉瘤夹闭术后并发急性缺血性卒中危险因素分析

Analysis of related risk factors of acute ischemic stroke after surgical clipping of ruptured intracranial aneurysms

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2 颅内破裂动脉瘤夹闭术后并发急性缺血性卒中危险因素分析

Analysis of related risk factors of acute ischemic stroke after surgical clipping of ruptured intracranial aneurysms

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