颅内动脉瘤夹闭术中动脉瘤破裂的影响因素及血流动力学参数的预测价值
邹成功 冯 浩 陈 兵 唐 辉 邵 川 孙 谋 杨 荣 何家全
川北医学院附属南充市中心医院，四川 南充 637000
通信作者：邹成功
【摘要】 目的 探究颅内动脉瘤夹闭术中动脉瘤破裂的影响因素及血流动力学参数对其预测价值。方法 回顾性分析选取 2018-04—2021-04 在南充市中心医院进行颅内动脉瘤夹闭术治疗的患者 96例为研究对象，根据患者术中动脉瘤是否破裂分为破裂组（64 例）及未破裂组（32 例）。所有患者术前均进行 CT 血管成像建模，比较 2 组患者血流动力学参数差异，分析颅内动脉瘤夹闭术中动脉瘤破裂的影响因素，并以 ROC 曲线分析血流动力学参数对术中动脉瘤破裂的预测价值。结果 破裂组患者年龄≥60岁、Hunt-Hess 分级为 III~IV 级、发病至手术时间>3 d 的患者显著多于未破裂组（P<0.05）。破裂组患者 AR 值、WSSGA、LSAR 分别为（1.31±0.41）Pa、（11.02±2.86）Pa/m、（0.33±0.14）%，高于未破裂组的（1.81±0.42） Pa、（14.60±3.42）Pa/m、（0.56±0.15）%（P<0.05），NWSSM 值（0.90±0.24）低于未破裂组的（0.59±0.16），差异具有统计学意义（P<0.05）。多因素 Logistic 回归分析显示，年龄≥60 岁、Hunt-Hess III~IV 级、发病至手术时间>3 d、AR、NWSSM 及 LSAR 均为颅内动脉瘤夹闭术中动脉瘤破裂的影响因素（P<0.05）。另 ROC 曲线结果显示，NWSSM、LSAR 预测动脉瘤破裂的 AUC 分别为 0.794、0.857，均具有一定准确性。结论 年龄、Hunt-Hess 分级、发病至手术时间、AR、NWSSM 及 LSAR 值均为颅内动脉瘤夹闭术中动脉瘤破裂的影响因素，且 NWSSM 及 LSAR 值对术中动脉瘤破裂预测价值良好。
【关键词】 颅内动脉瘤夹闭术中；动脉瘤破裂；血流动力学；影响因素；预测价值
【中图分类号】 R651.1+ 1 【文献标识码】 A 【文章编号】 1673-5110 （2022） 04-0421-05
基金项目：南充市科学技术局科技项目（编号：KY-16YFZJ0022）
DOI：10.12083/SYSJ.220125
Influencing factors of aneurysm rupture during intracranial aneurysm clipping and predictive value of hemodynamic parameters
ZOU Chenggong，FENG Hao，CHEN Bing，TANG Hui，SHAO Chuan，SUN Mou，YANG Rong，HE Jiaquan
Nanchong Central Hospital Affiliated to North Sichuan Medical College，Nanchong 637000，China
Corresponding author：ZOU Chenggong
【Abstract】 Objective To investigate the influencing factors of aneurysm rupture and hemodynamic parameters . Methods Retrospective analysis included 96 patients with intracranial aneurysm clipped in Nanchong Central Hospital Affiliated to North Sichuan Medical College from April 2018 to April 2021，who were divided into ruptured group（64 cases）and non-ruptured group（32 cases）according to whether the aneurysm ruptured during the operation. CT angiography modeling was performed for all patients preoperatively，the difference of hemodynamic parameters between the two groups was compared，the influencing factors of aneurysm rupture during intracranial aneurysm clipping were analyzed，and the predictive value of hemodynamic parameters for aneurysm rupture during intracranial aneurysm clipping was analyzed by ROC curve. Results The patients in the rupture group were significantly more than those in the non-rupture group（P<0.05）. The AR，WSSGA，and LSAR of the ruptured group were（1.31±0.41）Pa，（11.02±2.86）Pa/m，and（0.33±0.14）%，respectively，which were higher than those of the unruptured group（1.81±0.42）Pa，（14.60±3.42）Pa/m，and（0.56±0.15）%（P<0.05），the NWSSM value（0.90±0.24）was lower than that of the unruptured group（0.59±0.16）（P<0.05），and the difference was statistically significant. Multivariate Logistic regression analysis showed that age ≥60 years old，Hunt-Hess grade III-IV，time from onset to operation >3 days，AR，NWSSM and LSAR were all influencing factors of aneurysm rupture during intracranial aneurysm clipping（P<0.05）. In addition，the ROC curve results showed that the AUCs of NWSSM and LSAR for predicting aneurysm rupture were 0.794 and 0.857，respectively，both of which had certain accuracy. Conclusion Age，Hunt-Hess grade，onset to operation time，AR，NWSSM and LSAR values were all influencing factors for aneurysm rupture during intracranial aneurysm clamp operation，and NWSSM and LSAR values were of good predictive value for aneurysm rupture during intracranial aneurysm clamp operation.
【Key words】 Intracranial aneurysm clipping operation；Aneurysm rupture；Hemodynamics；Influencing factors；Predictive value
