颅内动脉瘤术中破裂的危险因素分析

目的探讨颅内动脉瘤开颅夹闭术中动脉瘤破裂可能的危险因素。方法回顾性分析278例采用显微神经外科技术，行颅内动脉瘤夹闭术的动脉瘤性蛛网膜下腔出血（SAH）患者的临床资料，对可能的影响因素，如年龄、性别、高血压病史、Hunt—Hess分级、Fisher分级、动脉瘤位置、大小、数目、动脉瘤颈宽窄、手术时机、临时阻断夹的应用与否，行单因素和多因素分析。结果278例患者320个动脉瘤中，81例患者81个动脉瘤发生术中破裂，发生率为25．3％。单因素分析显示，Hunt—Hess分级、动脉瘤颈宽窄、高血压病史、动脉瘤大小、手术时机及临时阻断夹的应用与否，是术中破裂的危险因素。多因素分析显示，Hunt—Hess分级（OR=1．549，P=0．029）、动脉瘤大小（OR=1．158，P=0．007）、手术时机（OR：0．699，P=0．038）、宽颈动脉瘤（OR=0．524，P=0．028）是术中存裂的独立危险因素。临时阻断夹的应用是独立的保护因素（OR=2．244，P=0．008）。结论颅内动脉瘤术中破裂主要与Hunt—Hess分级、动脉瘤大小、手术时机、动脉瘤颈宽窄和临时阻断夹的应用与否有关。

Intraoperative intracranial aneurysm rupture: an analysis of risk factors

Objective To discuss the potential risk factors of intraoperative aneurysmal rupture during craniotomy for aneurysm clipping.Methods The clinical data of 278 patients with aneurysmal subarachnoid hemorrhage(SAH),who were treated with microneurosurgical techniques for clipping intracranial aneurysm,were retrospectively analyzed.Single and multiple factor analyses were performed for potential influencing factors,such as age,sex,previous hypertension,Hunt-Hess scale,Fisher scale,site of aneurysm,size of aneurysm,number of aneurysm,size of aneurysm neck,timing of operation,and using or not using temporary arterial clip.Results Of the 278 patients with 320 aneurysms,81 aneurysms(25.3%) were ruptured in 81 patients during the procedure.Single factor analysis revealed that Hunt-Hess scale,size of aneurysm neck,previous hypertension,size of aneurysm,timing of operation,and using or not using temporary arterial clip were the risk factors of intraoperative intracranial aneurysm rupture.Multiple factor analysis revealed that Hunt-Hess scale((OR=)1.549,P=0.029),size of aneurysm(OR=1.158,P=0.007),timing of operation(OR=0.699,P=0.038),and wide-necked aneurysm(OR=0.524,P=0.028)were the independent risk factors.The use of temporary arterial clip was an independent protective factor(OR=2.244,P=0.008).(Conclusion) Intraoperative intracranial aneurysm rupture may mainly be associated with Hunt-Hess scale,size of aneurysm,timing of operation,size of aneurysm neck,and using temporary arterial clip.