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前交通动脉瘤破裂后继发脑梗死的相关因素研究

Predictors of cerebral infarction in patients with ruptured anterior communicating artery aneurysms
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摘要 目的探讨前交通动脉瘤破裂后脑梗死的发生率、危险因素及其可能的机制,为临床诊断和治疗提供一定参考依据。 方法回顾性分析2009年1月至2015年2月收治的319例前交通动脉瘤破裂患者,搜集相关临床资料,并通过CTA测量动脉瘤的形态学参数。采用成组t检验对脑梗死组与非脑梗死组患者的年龄、血流角度、血管角度进行比较;采用Mann-Whitney U检验对两组间动脉瘤大小、动脉瘤高度、垂直高度、瘤颈宽度、动脉瘤高度/血管管径比值、垂直高度/瘤颈宽度比值、动脉瘤角度、入院时的WFNS分级及Fisher分级进行统计;两组间的性别、高血压史、吸烟史、过去卒中史、治疗方式、大脑前动脉A1段形态学及CTA图像上所示血管痉挛采用卡方检验或Fisher确切概率法进行统计;在单因素分析的基础上,采用多元logistic分析中的逐步回归法进行自变量的筛选,以确定前交通动脉瘤破裂后继发脑梗死的独立危险因素。 结果319例患者中非脑梗死组253例、脑梗死组66例。非脑梗死组和梗死组年龄分别为(53±11)、(57±12)岁;入院时Fisher分级Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别为23(9.1%)、27(10.7%)、74(29.2%)、129例(51.0%),1(1.5%)、7(10.6%)、13(19.7%)、45例(68.2%);治疗方式中栓塞和夹闭分别为155(61.3%)、98例(38.7%),23(34.8%)、43例(65.2%);两组间差异具有统计学意义(t=-2.415,P=0.016;Z=-2.541,P=0.011;χ2=14.810,P〈0.001)。多因素logistic回归分析结果显示开颅夹闭术的治疗方式(OR=3.28,95% CI 1.84~5.86,P〈0.001)及Fisher分级Ⅳ级(OR=10.36,95% CI 1.34~80.29,P=0.025)仍有统计学意义。 结论前交通动脉瘤破裂后继发脑梗死可能与Fisher评分及治疗方式相关,年龄在两组间差异虽有统计学意义,但尚不能用来预测脑梗死的发生。 ObjectiveTo investigate the incidence and predictors of cerebral infarction in patients with ruptured ACoA aneurysms, and to provide diagnostic and therapeutic information. MethodsA total of 319 patients with ruptured ACoA aneurysms in our hospital from January 2009 to February 2015 were reviewed in this study. The author collected data regarding clinical characteristics, and measured the aneurysm morphologies on CTA images. Age, flow angle, vessel angle were analyzed by independent-samples t tests in patients with or without cerebral infarction. Mann-Whitney U tests were used for aneurysm size, aneurysm height, perpendicular height, neck size, size ratio, aspect ratio, aneurysm angle, World Federation of Neurosurgical Societies (WFNS) grade at admission and Fisher grade. Chi-square tests and Fisher's exact tests were used for sex, histories of hypertension, smoking and stroke, treatment modalities, anterior cerebral A1 segment configuration and angiographic vasospasm on CTA images. The multivariate logistic regression analyses were used to determine the independent risk factors of cerebral infarction using the stepwise regression method. ResultsOf the 319 patients, there were 253 without and 66 patients with cerebral infarction. Differences of age (53±11 vs 57±12,respectively;t=-2.415, P=0.016) , Fisher grade [Ⅰ 23(9.1%), Ⅱ 27(10.7%), Ⅲ 74(29.2%), Ⅳ 129(51.0%) vs Ⅰ 1(1.5%), Ⅱ 7(10.6%), Ⅲ 13(19.7%), Ⅳ 45(68.2%), respectively;Z=-2.541, P=0.035] and treatment modalities[endovascular coil embolization 155(61.3%), neurosurgical clipping 98(38.7%) vs endovascular coil embolization 23(34.8%), neurosurgical clipping 43(65.2%), respectively; χ2=14.810, P〈0.001] reached statistical significance. Multivariate analysis showed that Fisher grade Ⅳ (OR=10.36, 95% CI 1.34-80.29, P=0.025) and neurosurgical clipping (OR=3.28, 95% CI 1.84-5.86, P〈0.001)still had statistical significance. ConclusionsCerebral infarction in patients wi
作者 林博丽 陈丽芳 倪俊伟 岳婷 陈伟建 赵兵 陈勇春 夏能志 郭献忠 杨运俊 Lin Boli, Chen Lifang, Ni Junwei, Yue Ting, Chen Weijian, Zhao Bing, Chen Yongchun, Xia Nengzhi, Guo Xianzhong, Yang Yunjun.(Department of Radiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China)
出处 《中华放射学杂志》 CSCD 北大核心 2018年第6期415-420,共6页 Chinese Journal of Radiology
基金 浙江省卫生创新人才项目 温州市公益性科技计划项目(Y20160156,Y20140733,Y20170210)
关键词 动脉瘤 蛛网膜下腔出血 脑梗死 体层摄影术 X线计算机 Aneurysm Subarachnoid hemorrhage Cerebral infarction Tomography X-raycomputed
作者简介 通信作者:杨运俊,Email:wzfskyyj2011@163.com
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  • 1许建强,田德棒,马普红.颅内肿瘤术后脑血管痉挛的TCD监测[J].中华神经医学杂志,2004,3(6):442-444. 被引量:21
  • 2Oertel M, Boscardin WJ, Obrist WD, et al. Posttraumatic vasospasm: the epidemiology, severity, and time course of an underestimated phenomenon : a prospective study performed in 299 patients. J Neurosurg, 2005, 103: 812-824. 被引量:1
  • 3Hohlrieder M, Spiegel M, Hinterhoelzl J, et al. Cerebral vasospasm and ischaemic infarction in clipped and coiled intracranial aneurysm patients. Eur J Neurol, 2002, 9 : 389-399. 被引量:1
  • 4Rabinstein AA, Pichelmann MA, Friedman JA, et al. Symptomatic vasospasm and outcomes following aneurysmal subarachnoid hemorrhage: a comparison between surgical repair and endovascular coil occlusion. J Neurosurg, 2003,98 : 319-325. 被引量:1
  • 5Taha MM, Nakahara I, Higashi T, et al. Endovascular embolization vs surgical clipping in treatment of cerebral aneurysms: morbidity and mortality with short-term outcome. Surg Neurol,2006,66 : 277-284. 被引量:1
  • 6Molyneux AJ, Kerr RS, Yu LM, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized comparison of effects on survival,dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet,2005,366 : 809-817. 被引量:1
  • 7Hoh BL, Topcuoglu MA, Singhal AB, et al. Effect of clipping, craniotomy, or intravascular coiling on cerebral vasospasm and patient outcome after aneurismal subarachnoid hemorrhage. Neurosurgery, 2004,55: 779-786. 被引量:1
  • 8Origitano TC, al-Mefty O, Leonetti JP, et al. Vascular considerations and complications in cranial base surgery. Neurosurgery, 1994, 35 : 351-362. 被引量:1
  • 9el Hendawy M, Wronski J, Juniewicz H, et al. Cerebral vasospasm detection by TCD after supratentorial brain tumours surgery. Neurol Neurochir Pol, 2000,34Suppl 6 : 114-123. 被引量:1
  • 10Eberhard UHL, Jens L, Hans-Jakob S, et al. Intraoperative detection of early microvasospasm in patients with subarachnoid hemorrhage by using orthogonal polarization spectral imaging. Neurosurgery, 2003,52 : 1307-1317. 被引量:1

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