脑动脉瘤患者手术内破裂的结果和预测因素
Dongkyu Kim1, Sang Kyu Park1, Joonho Chung2
1Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Republic of Korea.
Acta neurochirurgica
|September 16, 2024
概括
在脑动脉瘤治疗期间的手术内断裂 (IPR) 与先前破裂的动脉瘤,手术剪切和更高的视角比率有关. IPR显著恶化了临床结果,除了已经破裂的动脉瘤的情况下.
科学领域:
- 神经外科 神经外科
- 干预神经病学 干预神经病学
- 脑血管疾病 脑血管疾病
背景情况:
- 程序内断裂 (IPR) 是脑动脉瘤治疗期间的一种严重并发症.
- 虽然已知风险因素,但需要进行更大规模的人口研究来确认这些风险因素.
研究的目的:
- 在大量患者队列中确定IPR的独立风险因素.
- 评估IPR对患者结果的临床影响.
主要方法:
- 在2009年至2018年期间治疗的4,233个脑动脉瘤的4,039名患者的回顾性审查.
- 多变量物流回归分析以确定知识产权的独立风险因素.
- 在治疗后3个月使用修改的兰金尺度 (mRS) 评估临床结果.
主要成果:
- IPR发生在1.44%的动脉瘤中.
- 独立的IPR风险因素包括先前破裂的动脉瘤 (OR 3.182),手术剪切 (OR 3.598) 和更高的视角比 (OR 1.310).
- 患有IPR的患者的不良结局率显著更高 (mRS ≥3) (18.0%与3.3%相比).
结论:
- 以前破裂的动脉瘤,手术剪切和更高的比例是IPR的独立风险因素.
- IPR显著增加了不良临床结果的风险,无论治疗方法如何,除了破裂动脉瘤的子组.
相关概念视频
Aneurysm I: Introduction
An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
Aneurysm III: Interprofessional Care
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
Aneurysm IV: Nursing Management
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
Hemorrhagic Stroke l: Introduction
A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
Increased Intracranial Pressure ll: Pathophysiology
Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...


