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刘创宏, 孔刚, 徐宏. 颅内破裂动脉瘤夹闭术后硬膜下积液及继发慢性硬膜下血肿发生的危险因素分析[J]. 中国临床医学, 2018, 25(6): 924-928.
引用本文: 刘创宏, 孔刚, 徐宏. 颅内破裂动脉瘤夹闭术后硬膜下积液及继发慢性硬膜下血肿发生的危险因素分析[J]. 中国临床医学, 2018, 25(6): 924-928.
Analysis of risk factors for subdural hydroma and chronic subdural hematoma after surgical clipping of ruptured intracranial aneurysms[J]. Chin J Clin Med, 2018, 25(6): 924-928.
Citation: Analysis of risk factors for subdural hydroma and chronic subdural hematoma after surgical clipping of ruptured intracranial aneurysms[J]. Chin J Clin Med, 2018, 25(6): 924-928.

颅内破裂动脉瘤夹闭术后硬膜下积液及继发慢性硬膜下血肿发生的危险因素分析

Analysis of risk factors for subdural hydroma and chronic subdural hematoma after surgical clipping of ruptured intracranial aneurysms

  • 摘要: 目的:探讨颅内破裂动脉瘤开颅夹闭手术后硬膜下积液或慢性硬膜下血肿发生的高危因素。方法:回顾性分析2010年1月至2018年7月本中心收治的57例经开颅夹闭手术治疗的颅内破裂动脉瘤患者的临床资料。术后进行动态头颅CT影像学评估,使用影像学软件对硬膜下积液或血肿的量进行测量。计算硬膜下并发症的发生率,对其演变情况进行随访,并进行单因素及多因素分析,探讨硬膜下并发症发生的危险因素。结果:颅内破裂动脉瘤开颅夹闭术后硬膜下积液及继发慢性硬膜下血肿的发生率分别为21.1%(12/57)、12.3%(7/57)。随访期内[平均(61.1±30.3)个月],7例硬膜下积液自行吸收,5例演变为慢性硬膜下血肿;前者积液量平均值显著少于后者[(26.4±14.6)mL vs (80.0±52.3) mL, P=0.002)]。单因素分析表明:男性、高龄(>60岁)、动脉瘤部位(大脑中动脉瘤、多发动脉瘤)、脑萎缩程度及腰大池引流史是颅内破裂动脉瘤夹闭术后硬膜下积液发生的潜在危险因素(P<0.05)。多因素回归分析表明:男性、高龄(>60岁)、动脉瘤部位(大脑中动脉瘤、多发动脉瘤)是动脉瘤开颅夹闭术后硬膜下积液发生的独立危险因素(P<0.05);其中,男性、高龄为硬膜下积液演变为慢性硬膜下血肿的独立危险因素(P<0.05)。结论:高龄(>60岁)、男性、大脑中动脉瘤、大脑中动脉瘤合并前交通动脉瘤与颅内破裂动脉瘤术后硬膜下并发症发生密切相关。

     

    Abstract: Objective:To investigate the risk factors for the postoperative occurrence of subdural complications, such as a subdural hydroma and resultant chronic subdural hematoma (CSDH), following surgical clipping of ruptured aneurysms. Methods:The data of 57 consecutive patients who underwent aneurysm clipping for ruptured aneurysms in the anterior cerebral circulation between January, 2010 and July, 2018 were reviewed retrospectively. The subdural hydromas and CSDH were identified based on dynamic CT scans after surgery, and their volume was measured using imaging software. The incidence of the postoperative subdural complications were calculated. The follow-up results of the subdural complications were also investigated. Uni- and multivariate logistic regression analysis were performed to evaluate the risk factors for the postoperative subdural complications. Results:The incidence of subdural hydroma and resultant CSDH was 21.1% (12/57) and 12.3% (7/57), respectively. Subdural hydroma resolved spontaneously in 5 cases and converted to a CSDH in 7 cases during the mean follow-up period of 61.1±30.3 months. The former was significantly less in volume than the latter ([26.4±14.6] mL vs [80.0±52.3] mL, P=0.002). The results of univariate analysis showed that male sex, advanced age (>60 years old), aneurysm distribution (middle cerebral artery aneurysm and multiple concomitant aneurysms), the degree of brain atrophy, and history of lumbar cistern drainage were all significant risk factors for the postoperative subdural hydroma. A multivariate analysis indicated that male sex, advanced age (>60 years old), middle cerebral artery aneurysm and multiple concomitant aneurysms were independent risk factors for the postoperative subdural hydroma, and the male sex and advanced age were independent risk factors for subdural hydroma that develops into CSDH. Conclusions:Advanced age(>60 years), male sex, middle cerebral artery aneurysm and multiple concomitant aneurysms might be the independent risk factors for the subdural hydroma and CSDH after surgical clipping of ruptured intracranial aneurysms.

     

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