Analysis Of Therapeutic Effect And Prognostic Factors In Patients With Ruptured Intracranial Anterior Circulation Aneurysm

Background 70?80% of the patients with subarachnoid hemorrhage are due to spontaneous subarachnoid hemorrhage caused by ruptured intracranial aneurysms.Patients without surgical intervention have a higher risk of death and disability.Microsurgical clipping and endovascular embolization are two main strategies for the treatment of ruptured intracranial aneurysms.In the past,microsurgery was mainly used to clip ruptured intracranial aneurysms,but craniotomy brought neurological damage to patients,and adverse symptoms such as cerebral vasospasm and cerebral ischemia may occur during the operation.postoperative complications such as pressure sores and hypoproteinemia are also likely to occur.In recent years,neurointerventional therapy provides a new way for the treatment of ruptured intracranial aneurysms.Objective To investigate the curative effect and prognostic factors of interventional embolization in patients with ruptured intracranial anterior circulation aneurysms.Methods The clinical data of 170 patients with aneurysmal subarachnoid hemorrhage in anterior intracranial circulation treated in our hospital from June 2017 to August 2019 were analyzed retrospectively.60 patients with minimally invasive interventional embolization were taken as the observation group and 110 patients with microsurgical clipping as the control group.The hospitalization time and operation time of the two groups were compared.The Glasgow(GCS)scores of the two groups were compared before operation,1 day,3 days,7 days and one month after operation,and the postoperative complications such as pulmonary infection and cerebral ischemia werecompared and analyzed.The patients who were followed up one month later were evaluated and compared with Glasgow prognosis score(GOS).At the same time,the possible influencing factors such as age,sex,blood press ure,embolization material,Hunt-Hess grade,aneurysm diameter,aneurysm site and postoperative complications were analyzed by univariate analysis,and the factors with differences were analyzed by multivariate Logistic regression analysis.Results There were 94 male/female patients with ruptured subarachnoid hemorrhage of anterior circulation aneurysms,aged 26 to 78 years,including 98 patients with good GOS score and 72 patients with poor GOS score,38 patients with good GOS score and 22 patients with poor GOS score in the observation group,60 patients with good GOS score and 50 patients with poor GOS score in the control group,and there was no significant difference in prognosis between the two groups after one month of follow-up.Compared with the craniotomy control group,the interventional embolization group had shorter hospitalization time,shorter operation time,higher GCS on the first day,third day and one week after operation,and less postoperative complications such as hypoproteinemia,pulmonary infection,cerebral ischemia and ulcer,but there was no significant difference in electrolyte disturbance and GCS score before and one month later between the two groups.Further statistical analysis of the patients treated with interventional embolization showed that there were significant differences in hypertension,embolic materials,Hunt-Hess grade and aneurysm diameter between the good prognosis group and the poor prognosis group(P<0.05).Multivariate Logistic regression analysis showed that hypertension,Hunt-Hess grade ? ? ?,aneurysm diameter?4.5mm and simple coil embolization were independent prognostic factors(P<0.05).Conclusion Interventional embolization in patients with ruptured intracranial anterior circulation aneurysms has the advantages of short course of disease,quick operation time and few complications such as hypoproteinemia,pulmonary infection,cerebral ischemia and ulcer.the prognosis is closely related tohypertension,Hunt-Hess grade ? ? ?,aneurysm diameter?4.5mm and simple coil embolization.