| ObjectiveTo analyze the clinical characteristic of anterior circulating intracranial aneurysms,to explore the factors that influence the prognosis of patients with anterior circulating a SAH and offer reference for determining the treatment strategy of intracranial circulation aneurysm.Methods Retrospective analyze the clinical data of patients with SAH,who treated in the neurosurgical department of the First Affiliated Hospital from January 2011 to December 2014.Selecting patients who age of 18 years old or more,in CT angiography(CTA)and digital subtraction angiography(DSA)diagnosis of anterior circulating aneurysms;no serious heart,liver and kidney,neuropsychological,uncontrollable endocrine disease,without pregnancy and lactation.All of patients were followed up by telephone survey or outpatients visit,the time ranged from 6 months to 54 months.A total of 321 patients in line with the standard,including 104 male case(33.3%)and 208 female cases(66.7%).These patients age from 23 to 76,including 14 patients(4.5%)age less than 40 year old,198 patients(63.5%)age from 40 to 60 and 100 patients(32.1%)age more than 60.The prognosis was presented by the Glasgow Outcome Scale(GOS),5 to 4 were divided into good prognosis,and 3 to 1 were poor.All of investigated information were registered one by one,such as sex,age,preoperative Hunt-Hess Scale,operation time,history of hypertension,position of aneurysm and so on.The above clinical data were statistically analyzed by SPSS 19.0 software,in which the size of test was 0.05.First,chi-square test is implemented for significant data selection,then the unconditioned binary classification Logistic regression is applied to analyze.Result 1.Overall result: 312 patients of Clipping Aneurysms of Anterior Circulation caused by spontaneous subarachnoid hemorrhage,among which,there are 18 with oculomotor nerve palsy,26 with limb movement disorder,2 with numbness,10 with twitch,5 with aphasia,3 with facial paralysis,and 3 with ocular fundus hemorrhage.After 6 – 54 months postoperative follow-up(average 30 months),GOS evaluation results show that there are 170(54.5% among total)wit slight defect(score 5),65(20.8%)with moderately disabled but can self care(score 4),29(9.3%)with sick with severe and not self-caring(score 3),2(0.6%)with persistent vegetative status and 46(14.7)dead.Good prognosis group consists of 235 with GOS score 4~5,75.3% of total,and poor prognosis group consists of 77 with GOS 1~3,24.7% of total.2.Chi-square test: 9 relative factors(P value <0.05)shows significant impact on differences of prognosis of the patients,which are Age,Preoperative Hunt-Hess grading,Surgery timing,History of hypertension,Improved Fisher scale,History of consciousness disorder,Abnormal pupil,Aspiration pneumonia,and Rupture of aneurysm in surgery.And 3 relative factors(P value >0.05)shows none significant impact,which are the Location of Aneurysm,Gender,and Postoperative lumbar puncture.3.Unconditioned binary classification Logistic regression: Age and Preoperative Hunt-Hess grading are significantly relative factors(P<0.05)on differences of prognosis of the patients,which Wals value are respectively 4.749 and 24.493;OR value respectively 0.537 and 2.752;and 95%CI is respectively(0.306 ~ 0.940)and(1.843 ~ 4.110).History of hypertension,Abnormal pupil and Rupture of aneurysm in surgery show non-significant impact,and their P value is larger than 0.05.Conclusion:1.Age,pre-operative Hunt-Hess Scale are the factors that influenced the prognosis of the anterior circulating intracranial aneurysm.The older age and the higher Hunt-Hess scale are correlated negatively with prognosis outcome.2.For doctors with professional training and rich operational experience,early and non-early operations have no difference on the prognosis of patients with a SAH.However,in order to prevent aneurysm rupture again,the operation should be considered as soon as possible.3.With reasonable microsurgery,patients will be satisfied with prognosis. |
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