颅内破裂动脉瘤患者术前再出血危险因素分析

目的 探讨颅内破裂动脉瘤术前再出血的相关危险因素，为预防早期再出血提供依据。方法 采用回顾性病例对照的方法，对450例确诊的颅内破裂动脉瘤患者进行调查。依据术前是否发生再出血将患者分为无出血组和再出血组，采用单因素分析、Logistic回归法来筛选影响术前再出血的危险因素。结果 颅内破裂动脉瘤术前再出血发生率高达23.56%（106/450）；Logistic回归分析显示，高血压（OR 4.221，95%CI 2.969～5.472，P <0.001）、合并脑血管痉挛（OR 2.015，95%CI 1.274～2.756，P =0.005）、癫痫（OR 3.093，95%CI 1.980～4.206，P <0.001）、DSA检查（OR 1.684，95%CI 1.103～2.265，P =0.002）、动脉瘤形状不规则（OR 2.465，95%CI 1.887～3.042，P <0.001）、肿瘤直径≥10 mm（OR 3.046，95%CI 2.060～4.031，P <0.001）、剧烈咳嗽（OR 3.594，95%CI 2.447～4.741，P <0.001）、情绪异常波动（OR 2.756，95%CI 1.928～3.585，P =0.002）、过早搬动或下床活动（OR 4.226，95%CI 2.769～5.683，P <0.001）、用力排便（OR 2.451，95%CI 1.810～3.092，P <0.001）、Hunt-Hess分级高（OR 1.073，95%CI 1.031～1.114，P <0.001）等因素为术前再出血的独立危险因素。结论 颅内破裂动脉瘤患者入院后术前仍然有较高的再出血发生率，其独立危险因素较多，应针对这些危险因素采取干预措施，降低术前再出血发生率。

Risk Factors of Preoperative Rebleeding of Ruptured Intracranial Aneurysms

Objective To explore the risk factors of preoperative rebleeding of ruptured intracranial aneurysms,
to provide reference for preventing aneurysm rebleeding.
Methods This is a retrospective case-control study. A total of 450 cases diagnosed with ruptured
intracranial aneurysm patients were included. According to whether or not there was rebleeding
before surgery, all the patients were divided into non-rebleeding group and rebleeding group.
Multivariate logistic regression analysis was used to analyze the risk factors of aneurysm rebleeding.
Results The rate of preoperative rebleeding of ruptured intracranial aneurysms reached up to
23.56% (106/450). Logistic regression analysis showed that the following factors of hypertension
(OR 4.221, 95%CI 2.969-5.472, P <0.001), cerebral angiospasm (OR 2.015, 95%CI 1.274-
2.756, P =0.005), epilepsy (OR 3.093, 95%CI 1.980-4.206, P <0.01), DSA examination (OR 1.684,
95%CI 1.103-2.265, P =0.002), irregular shape of aneurysm (OR 2.465, 95%CI 1.887-3.042,
P <0.001), aneurysm diameter ≥10 mm (OR 3.046, 95%CI 2.060-4.031, P <0.001), severe cough
(OR 3.594, 95%CI 2.447-4.741, P <0.001), abnormal mood fluctuation (OR 2.756, 95%CI 1.928-
3.585, P =0.002), earlier moving or out-of-bed activity (OR 4.226, 95%CI 2.769-5.683, P <0.001),
forced defecation (OR 2.451, 95%CI 1.810-3.092, P <0.001) and Hunt-Hess grade (OR 1.073,
95%CI 1.031-1.114, P <0.001) were all dependent risk factors of rebleeding of ruptured intracranial aneurysm before surgery.
Conclusions The incidence of rebleeding of ruptured intracranial aneurysm before surgery was
still high, and there were many independent risk factors affecting aneurysm rebleeding. According
to the risk factors, intervention measures should be taken to prevent the occurrence of aneurysm
rebleeding.