关于脑动静脉畸形术后神经功能障碍的影响因素分析(1)
[摘要] 目的 分析和研究腦动静脉畸形患者术后发生神经功能障碍的影响因素。方法 方便选取该院2014年1月—2018年1月在神经外科接受手术治疗的40例患脑动静脉畸形疾病患者，术前和前术后7 d采用Modified Rankin Scale(MRS)评分量表评测患者神经功能情况，如量表评分降低则认定为术后存在神经功能障碍。评分量表包含患者一般资料、实验室和病理学检测指标等，通过多个因素分析得出术后神经功能障碍的危险因素。 结果 40例中8例(20.0%)患者量表评分降低，认定为存在一定程度的神经功能障碍，其中存在既往颅内出血史患者26例中有4例存在功能障碍(15.38%)，低于无颅内出血史患者14例中4例(28.57%)(χ2=8.123，P=0.007);患者脑内畸形血管团不存在或者未位于功能区的25例患者中3例存在功能障碍(12.00%)，低于位于功能区患者15例中5例(33.33%)(χ2=14.011，P=0.001);Ang-1值较高的患者21例中4例存在功能障碍(19.05%)，也低于Ang-1值较低的患者19例中4例(21.05%)(χ2=4.895，P=0.027)。而深静脉引流患者16例中7例(43.75%)存在功能障碍，高于无深静脉引流患者24例中1例(4.17%)(χ2=47.141，P=0.000);脑内畸形血管团位置体积较大的患者24例中6例(25.00%)存在功能障碍，高于体积较小的患者12例中1例(8.33%)(χ2=7.572，P=0.006);Spetzler-Martin分级大于Ⅲ级的患者29例中5例(17.24%)存在功能障碍，高于小于Ⅲ级的患者11例中3例(27.27%)、(χ2=19.471，P=0.000);Ang-2值偏高的患者20例中5例存在功能障碍(25.00%)，也高于Ang-2值偏低的患者20例中3例(15.00%)(χ2=9.373，P=0.001)。 结论 脑动静脉畸形患者在手术后有一定概率发生神经功能障碍。患者存在既往颅内出血史、患者脑内畸形血管团不存在或者未位于功能区或Ang-1值较高的可一定程度上降低术后神经功能障碍的风险;而深静脉引流、脑内畸形血管团位置位于功能区且体积较大、Spetzler-Martin分级大于Ⅲ级和Ang-2值偏高会增加患者术后神经功能障碍的风险。
[关键词] 脑动静脉畸形;术后;神经功能障碍;影响因素
[中图分类号] R651.12 [文献标识码] A [文章编号] 1674-0742(2019)08(b)-0053-04
[Abstract] Objective To analyze and study the influencing factors of postoperative neurological dysfunction in patients with cerebral arteriovenous malformation. Methods A total of 40 patients with cerebral arteriovenous malformation who underwent surgery in neurosurgery from January 2014 to January 2018 were enrolled. The patients were evaluated by Modified Rankin Scale (MRS) scale before and after surgery. Neurological status， such as a decrease in the scale of the scale was considered to be neurological dysfunction after surgery. The rating scale includes general patient data， laboratory and pathological indicators， and the risk factors for postoperative neurological dysfunction were analyzed by multiple factors. Results 8 of the 40 patients (20.0%) had a reduced score on the scale and were identified as having a certain degree of neurological dysfunction. Among them， 4 of 26 patients with previous history of intracranial hemorrhage had dysfunction (15.38%)， lower than none of the 14 patients with a history of intracranial hemorrhage， 4(28.57%)(χ2=8.123， P=0.007);4 patients with dysfunctional vascular mass in the brain or 25 patients not in the functional area had dysfunction (12.00%)， 5 patients (33.33%) out of 15 patients in the functional area (χ2=14.011， P=0.001); 3 of 21 patients with higher Ang-1 values had dysfunction (19.05%)， also lower than that of the 19 patients with a lower Ang-1 value， 4 (21.05%) (χ2=4.895， P=0.027). There were dysfunction in 7 of 16 patients (43.75%) with deep venous drainage， 1(4.17%) of 24 patients without deep venous drainage (χ2=47.141， P=0.000); intracranial malformed vascular mass of the 24 patients with large volume， 6 (25.00%) had dysfunction， 1(8.33%) of the 12 patients (χ2=7.572， P=0.006)， and the Spetzler-Martin classification was larger than the smaller grade III 5 of the 29 patients (17.24%) had dysfunction， 3 of the 11 patients(27.27%)(χ2=19.471， P=0.000)， and patients with high Ang-2 values of 20 with 5 had dysfunction (25.00%)， which was also higher than 3 of the 20 patients with low Ang-2 value (15.00%) (χ2=9.373， P=0.001). Conclusion Patients with cerebral arteriovenous malformation have a certain probability of developing neurological dysfunction after surgery. Patients with a history of intracranial hemorrhage， absence of a patient's intracranial malformed vascular group， or absence of a functional area or a higher Ang-1 value may reduce the risk of postoperative neurological dysfunction to some extent; and deep vein drainage， intracranial malformation vessels location of the cluster is located in the functional area and is relatively large. The Spetzler-Martin grade is greater than grade III and the high Ang-2 value increases the risk of postoperative neurological dysfunction., http://www.100md.com(韩冲 焦松 李刚 夏湘平 肖华 姚声涛)
[关键词] 脑动静脉畸形;术后;神经功能障碍;影响因素
[中图分类号] R651.12 [文献标识码] A [文章编号] 1674-0742(2019)08(b)-0053-04
[Abstract] Objective To analyze and study the influencing factors of postoperative neurological dysfunction in patients with cerebral arteriovenous malformation. Methods A total of 40 patients with cerebral arteriovenous malformation who underwent surgery in neurosurgery from January 2014 to January 2018 were enrolled. The patients were evaluated by Modified Rankin Scale (MRS) scale before and after surgery. Neurological status， such as a decrease in the scale of the scale was considered to be neurological dysfunction after surgery. The rating scale includes general patient data， laboratory and pathological indicators， and the risk factors for postoperative neurological dysfunction were analyzed by multiple factors. Results 8 of the 40 patients (20.0%) had a reduced score on the scale and were identified as having a certain degree of neurological dysfunction. Among them， 4 of 26 patients with previous history of intracranial hemorrhage had dysfunction (15.38%)， lower than none of the 14 patients with a history of intracranial hemorrhage， 4(28.57%)(χ2=8.123， P=0.007);4 patients with dysfunctional vascular mass in the brain or 25 patients not in the functional area had dysfunction (12.00%)， 5 patients (33.33%) out of 15 patients in the functional area (χ2=14.011， P=0.001); 3 of 21 patients with higher Ang-1 values had dysfunction (19.05%)， also lower than that of the 19 patients with a lower Ang-1 value， 4 (21.05%) (χ2=4.895， P=0.027). There were dysfunction in 7 of 16 patients (43.75%) with deep venous drainage， 1(4.17%) of 24 patients without deep venous drainage (χ2=47.141， P=0.000); intracranial malformed vascular mass of the 24 patients with large volume， 6 (25.00%) had dysfunction， 1(8.33%) of the 12 patients (χ2=7.572， P=0.006)， and the Spetzler-Martin classification was larger than the smaller grade III 5 of the 29 patients (17.24%) had dysfunction， 3 of the 11 patients(27.27%)(χ2=19.471， P=0.000)， and patients with high Ang-2 values of 20 with 5 had dysfunction (25.00%)， which was also higher than 3 of the 20 patients with low Ang-2 value (15.00%) (χ2=9.373， P=0.001). Conclusion Patients with cerebral arteriovenous malformation have a certain probability of developing neurological dysfunction after surgery. Patients with a history of intracranial hemorrhage， absence of a patient's intracranial malformed vascular group， or absence of a functional area or a higher Ang-1 value may reduce the risk of postoperative neurological dysfunction to some extent; and deep vein drainage， intracranial malformation vessels location of the cluster is located in the functional area and is relatively large. The Spetzler-Martin grade is greater than grade III and the high Ang-2 value increases the risk of postoperative neurological dysfunction., http://www.100md.com(韩冲 焦松 李刚 夏湘平 肖华 姚声涛)