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目的分析影响颅内破裂动脉瘤患者预后的因素。方法回顾性分析1996年1月—2009年1月连续收治的966例(1052个动脉瘤)颅内破裂动脉瘤患者的病历资料,其中273例行显微外科手术,662例行血管内栓塞治疗,31例未经手术治疗。3个月后对预后行改良Rankin量表评分。评价性别、年龄、动脉瘤部位和大小、Fisher分级、Hunt-Hess分级、是否伴有急性重度脑积水、治疗时机、是否手术治疗、手术方式(显微外科手术或血管内治疗)、术中动脉瘤再破裂、有重度脑积水者是否术中行终板造瘘及术后是否行脑脊液持续外引流12项可能影响预后的因素进行多因素Logistics回归分析。结果①966患者中,预后良好率为72.0%(695/966),预后不良率为23.1%(223/966),病死率为5.0%(48/966)。②多因素Logistics回归分析显示,年龄>60岁(OR:8.36,95%CI:2.23～11.68;P<0.01)、Fisher分级≥Ⅲ级(OR:9.65,95%CI:3.09～13.48;P<0.01)、Hunt-Hess分级≥Ⅳ级(OR:7.49,95%CI:1.12～13.25;P<0.01)、未手术治疗(OR:8.23,95%CI:5.59～20.89;P<0.01)、术中动脉瘤再破裂(OR:8.69,95%CI:5.12～19.51;P<0.01)、非早期治疗(>3d;OR:2.36,95%CI:1.65～12.46;P<0.01)及术后未行脑脊液持续外引流(OR:3.08,95%CI:1.07～8.63;P<0.01),是影响患者预后的独立危险因素。结论年龄、Fisher分级、Hunt-Hess分级、是否手术治疗、治疗时机、术中动脉瘤再破裂及是否脑脊液持续外引流是影响患者预后的独立危险因素。
Objective To analyze the factors affecting the prognosis of intracranial ruptured aneurysms. Methods The clinical data of 966 patients (1052 aneurysms) with intracranial aneurysm consecutively admitted from January 1996 to January 2009 were retrospectively analyzed. 273 patients underwent microsurgery and 662 patients underwent endovascular embolization , 31 cases without surgery. Three months later, the prognosis improved Rankin scale score. The gender, age, location and size of the aneurysm, Fisher’s grade, Hunt-Hess grade, acute severe hydrocephalus, timing of treatment, surgical treatment, surgical procedure (microsurgery or endovascular treatment), surgery Aneurysm rupture, severe hydrocephalus who underwent surgery and endoscopic ciliary fistula and cerebrospinal fluid after continuous external drainage of 12 factors that may affect the prognosis of the multi-factor Logistic regression analysis. Results ① The 966 patients had a good prognosis rate of 72.0% (695/966), with a negative prognosis rate of 23.1% (223/966) and a case fatality rate of 5.0% (48/966). Logistic regression analysis showed that the age of> 60 years (OR: 8.36,95% CI: 2.23-11.68; P <0.01), Fisher grade≥Ⅲ (OR: 9.65,95% CI 3.09-13.48, P < (OR: 8.23, 95% CI: 5.59 ~ 20.89; P <0.01). The patients with Hunt-Hess grade ≥ Ⅳ (OR: 7.49,95% CI: 1.12-13.25; (OR: 8.69, 95% CI: 5.12-19.51; P <0.01), non-early treatment (> 3d; OR: 2.36,95% CI: 1.65-12.46; P <0.01) Continuous external drainage of cerebrospinal fluid (OR: 3.08, 95% CI: 1.07 ~ 8.63; P <0.01) was an independent risk factor for prognosis. Conclusion Age, Fisher’s classification, Hunt-Hess grade, surgical treatment, timing of treatment, intraoperative aneurysm rupture, and continuous external drainage of cerebrospinal fluid are independent risk factors influencing the prognosis of patients.