| Objective:Delayed cerebral ischemia(DCI)is one of the serious complications of intracranial aneurysmal subarachnoid hemorrhage.For disability and death,DCI play an important role in such patients.At present,the treatment of ruptured intracranial aneurysm is mainly coiling and clipping,but for these two different surgical procedures after the occurrence of DCI there is no consensus.The aim of this study was to compare and analyze the incidence of DCI after clipping or coiling and to explore the risk factors for DCI.In order to early assessment of the patient’s condition to predict the occurrence of DCI,thereby reducing the incidence of postoperative DCI,the maximum reduction in patients with morbidity and mortality,to improve the prognosis of patients.Methods: A total of 236 patients with aneurysms diagnosed by CT angiography(CTA)or digital subtraction angiography(DSA)were enrolled in Department of Neurosurgery,Tianjin Medical University from March 2013 to May 2015.Patients were divided into clipping group(n=135)and coiling group(n=101).DCI was diagnosed according to Transcranial Doppler(TCD),CT or MRI or Digital Subtraction Angiography(DSA).The clinical characteristics were compared between two groups,including gender,age,medical history,GCS score,Hunt-Hess grade,Fisher grade,WFNS grade,aneurysm location,prognosis and incidence of DCI.Risk factors for DCI were investigated by Logistic regression analysis.(3)Results:(1)In the clipping group,DCI(26.7%)occurred in 36 cases,10 cases of DCI(10.9%)occurred in the coiling group,and the incidence of clipping was higher than that of the coiling group(P <0.01).(2)Comparison of DCI incidence in patients with single aneurysm at different locations,there was no significant difference in the incidence of DCI between the two groups(P> 0.01).There was no significant difference in the incidence of DCI between the two groups of patients with multiple aneurysms(P> 0.01).(3)There was no significant difference in the incidence of DCI(26.1%,29/111)between patients with single aneurysms and the incidence of DCI in patients with multiple aneurysms(29.2%,7/24)(c 2 = 0.093,P = 0.760).There was a significant difference in the incidence of DCI(6.0%,5/84)between patients with single aneurysms and the incidence of DCI in patients with multiple aneurysms(35.3%,6/17)(c 2 = 9.701,P = 0.002).(4)Two groups of postoperative complications and prognosis:47 cases of DCI patients,6 cases showed both the deterioration of clinical symptoms,but also CT new infarct or ischemic lesions,4 cases showed only CT new ischemic or infarction,more than 37 cases showed only clinical symptoms The The time of DCI was 2 ~ 15 days,mean(5.85 ± 3.20)d.(5)The patients were followed up for 6 months.The nonunion rate of clipping and coiling group was17.0% and 25.7%(P> 0.01),the overall mortality was 11.0%,the former mortality rate was lower than that of the latter(5.9% vs.17.8 %,P <0.01).(6)The patients before the various scores(into a binary variable),postoperative complications,prognosis and other factors as a grouping factor.The incidence of DCI was compared by univariate analysis(the test level is taken as α = 0.05).Univariate analysis showed that age,Fisher grade,Hunt-Hess grade,postoperative pulmonary infection,postoperative intracranial infection,and surgical methods were statistically significant(P <0.05).Logistic regression analysis showed that Fisher grade 3 ~ 4,postoperative pulmonary infection and craniotomy were the independent risk factors of DCI.Conclusion:DCI is an important factor in the high morbidity and mortality of patients with aneurysm after surgery.The incidence of DCI was lower in patients undergoing clip than coil.For preoperative Fisher classification is higher,the surgical choice of craniotomy,postoperative pulmonary infection in patients with more prone to delayed cerebral ischemia,it should be closely guarded to prevent the occurrence of DCI.Pay close attention to the risk factors associated with DCI to a certain extent to improve the prognosis of patients after aneurysm surgery. |
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