颅内多发动脉瘤个体化治疗研究及预后分析

Individualized treatment and prognostic analysis of multiple intracranial aneurysms

摘要:

目的 探讨颅内多发动脉瘤（Multiple Intracranial Aneurysms，MIAs）个体化治疗方案及预后影响因素。方法 回顾性分析106例MIAs患者的完整资料。分别应用单因素分析及多因素Logistic回归分析术前各因素、治疗方案对治疗效果的影响。结果 出院时MIAs患者GOS评分预后良好（4-5分）85例，差（1-3分）21例。各治疗组GOS评分：手术58例中，良好45例；介入44例中，良好37例；介入+手术4例中，良好3例。单因素分析结果显示MIAs患者年龄、部位、术前Fisher及Hunt-Hess分级与预后相关（P<0.05），多因素Logistic回归分析显示年龄、部位及Fisher分级与预后相关（P<0.05）。结论 患者年龄、部位、术前Fisher和Hunt-Hess分级是影响MIAs患者术后疗效的关键因素。根据患者的实际情况选择开颅手术、介入栓塞或开颅手术+介入栓塞等个体化治疗方案是改善MIAs患者预后的关键。

Abstract:

Objective To investigate the individualized treatment of multiple intracranial aneurysms (MIAs) and the prognostic factors for MIAs.Methods A retrospective analysis was performed on the complete clinical data of 106 patients with MIAs. Univariate analysis and multivariate logistic regression analysis were used to analyze the effects of different preoperative factors and treatment regimens on treatment outcomes of the patients with MIAs.Results Of the 106 patients, 85 had a higher Glasgow Outcome Scale (GOS) score (4-5), indicating good prognosis, and 21 had a lower GOS score (1-3), indicating poor prognosis. GOS scores for different treatment groups:45 of 58 patients undergoing surgery had a good prognosis (GOS 4-5); 37 of 44 patients receiving interventional embolization had a good prognosis (GOS 4-5); 3 of 4 patients undergoing surgery combined with interventional embolization had a good prognosis (GOS 4-5). Univariate analysis showed that age, location, and preoperative Fisher grade and Hunt-Hess grade of MIAs were associated with prognosis (P<0.05). Multivariate logistic regression analysis showed that age, location, and Fisher grade of MIAs were associated with prognosis (P<0.05).Conclusions Age, location, and preoperative Fisher grade and Hunt-Hess grade are key factors affecting the treatment outcomes of patients with MIAs. According to the actual condition of patients, choosing individualized treatment regimen (such as craniotomy, interventional embolization, and craniotomy combined with interventional embolization) is the key to improving the prognosis of patients with MIAs.