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目的 探讨影响出血性颅内动静脉畸形(AVM)显微手术治疗预后的出血性因素.方法 回顾性连续纳入2012年1月至2017年3月华中科技大学同济医学院附属同济医院神经外科同一血管组经显微手术治疗且符合纳入标准的出血性AVM患者62例.根据术后6个月随访时改良Rankin量表(mRS)评分,将患者分为预后良好组(48例,mRS≤2分)和预后不良组(14例,mRS>2分).收集患者的一般资料,包括性别、年龄、原发高血压病史、既往脑出血史、入院格拉斯哥昏迷评分(GCS)、AVM位置、AVM大小、AVM静脉引流类型、Spetzler-Martin分级、合并动脉瘤、合并脑室出血、出血部位及出血量等,进行单因素分析和多因素Logistic回归分析影响出血性AVM手术预后的出血相关因素.结果 (1)两组患者性别、年龄、原发性高血压病史、脑出血病史的组间差异均无统计学意义(均P>0.05),入院时GCS的差异有统计学意义(P2)according to the modified Rankin scale (mRS)scores during the follow up at 6 months after the operation. The general information of the patients were collected,including gender,age,history of primary hypertension, history of previous cerebral hemorrhage,Glasgow Coma Scale (GCS)score on admission,AVM location,size of AVM,type of AVM venous drainage,Spetzler-Martin grade,combined aneurysm,combined intraventricular hemorrhage,site of hemorrhage,and volume of hemorrhage. Univariate analysis and multivariate logistic regression analysis were used to analyze the hemorrhage-related factors affecting the prognosis of hemorrhagic AVM operation. Results (1)There were no significant differences in gender,age,history of primary hypertension,history of cerebral hemorrhage between the two groups (all P > 0. 05),and there was significant difference in GCS on admission (P < 0. 05). (2)Compared with the the good prognosis group,there were significant differences in functional area AVM (33. 3% [16 /48]vs. 12 /14),Spetzler- Martin grade ≤Ⅱ (85. 4% [41 /48]vs. 6 /14),volume of hemorrhage ≥30 ml (10. 4% [5 /48]vs. 8 /14), and intraventricular hemorrhage (8. 3% [4 /48]vs. 7 /14)in the poor prognosis group (all P 0. 05). (3)Multivariate logistic regression analysis was used to analyze the independent variables related to bleeding in univariate analysis,the results showed that intraventricular hemorrhage (OR,11. 000,95% CI 1. 722 -46. 231,P =0. 009)and volume of hemorrhage ≥30 ml (OR,11. 467,95% CI 2. 029 -44. 894,P = 0. 004)were the independent risk factors for poor prognosis. Conclusion The intraventricular hemorrhage and volume of hemorrhage ≥30 ml may be the independent risk factors affecting prognosis of patients of hemorrhagic AVM surgery,however,further validation is needed.