【作者】 苏万东；

【导师】 吴承远；

【作者基本信息】 山东大学 ， 外科学， 2004， 博士

【摘要】 目的 通过对前循环动脉瘤夹闭术后影响疗效的多种因素进行分析,发现各种具有明显统计学意义的指标,期望对前循环动脉瘤夹闭术起指导作用,使患者获得最佳的手术疗效。 方法 回顾性分析了山东大学齐鲁医院神经外科在2001年1月～2003年11月间应用显微手术夹闭的资料完整的83例前循环动脉瘤患者的临床资料,将性别、年龄、动脉瘤的破裂次数、动脉瘤最后一次破裂距手术的时间间隔、入院时的意识状况、术前Hunt和Hess分级、术前头颅CT扫描情况、动脉瘤的部位、动脉瘤的个数、动脉瘤瘤囊的最大径、是否行侧脑室体外引流术、手术后患者的意识状态、手术后患者是否瘫痪等十三项统计学指标与患者的预后情况(Glasgow outcome scale, GOS)进行统计学分析,应用卡方检验、两样本比较的秩和检验、多样本比较的秩和检验等检验方法,获得统计学结果。 结果 统计分析结果如下:1.患者性别与术后疗效(GOS)的关系采用卡方检验,结果显示p=0.97>0.05,没有统计学意义。说明男性和女性患者的预后没有差异,性别没有差异性。2.患者年龄与术后疗效(GOS)的关系采用多样本比较的秩和检验,结果显示p=0.047<0.05,有统计学意义。说明患者年龄越大的预后越差,尤其是年龄大于60岁以上的患者。3.动脉瘤的破裂次数与术后疗效(GOS)的关系采用两样本比较的秩和检验,结果显示p=0.000<0.01,有显著性统计学意义。说明破裂次数超过2次以上的患者预后比破裂1次的患者预后差。4.患者最后一次破裂距手术的时间间隔与术后疗效(GOS)的关系采用多样本比较的秩和检验,结果显示p=0.008<0.01,有显著性统计学意义。说明动脉瘤最后一次破裂距手术的时间间隔越长的预后越好,越短的预后越差。5.患者入院时意识状态与术后疗效(GOS)的关系采更多还原

【Abstract】 OBJECTIVE: To find all kinds of significantly statistical indexes by analysing the influencing multiple factors of the prognosis after clipping aneurysms of anterior willis’s circulation can be helpful to the surgical operation of anterior willis’s circulation aneurysms, and also can help the patients obtain the best surgical outcomes.METHODS: Primitive clinical materials of 83 cases of anterior willis’s circulation aneurysms which were clipped by neurosurgeons in Qilu Hospital of Shandong University from Jan. 2001 to Nov. 2003 were analysed by using Chi-Square Test, Mann-Whitney Test and Kruskal-Wallis Test. The influencing factors such as: sex, age, the aneurysm rupture times, the time interval between the last aneurysm rupture and the surgical operation, the consciousness in admission, the pre-operational Hunt-Hess grading , the pre-operational CT scan, the aneurysm site, the aneurysm number, the largest diameter of aneurysm, ventriculostomy or not, the postsurgical consciousness, the postsurgical paralysis or not, were analysed with the patients’ Glasgow outcome scale(GOS), then we obtained the statistical results.RESULTS: The statistical results show as followed: 1. The relationship between sex and postsurgical outcome was analysed with Chi-Square Test, the result shows no statistical difference because of the p=0.97>0.05. It shows that there is nodifference between male and female in the postsurgical prognosis. 2. The relationship between age and postsurgical outcome was analysed with Kruskal-Wallis Test, the result shows statistical difference because of the p=0.047<0.05. It shows that old patients have poorer prognosis than the young ones , especially the ones older than 60 years old. 3. The relationship between the aneurysm rupture times and postsurgical outcome was analysed with Mann-Whitney Test, the result shows significantly statistical difference because of the p=0.000<0.01. It shows that the prognosis of patients with one-times rupture is better than the ones with more than one-times. 4. The relationship between the time interval between the last aneurysm rupture and the surgical operation and postsurgical outcome was analysed with Kruskal-Wallis Test, the result shows significantly statistical difference because of the p=0.008<0.01. It shows that the postsurgical prognosis of the long time interval is better than the short one. 5. The relationship between the consciousness in admission and postsurgical outcome was analysed with Chi-Square Test, the result shows significantly statistical difference because of the p=0.00<0.01. It shows that the patients with consciousness in admission have better postsurgical outcome than the ones with unconsciousness. 6. The relationship between the pre-operational Hunt-Hess grading and postsurgical outcome was analysed with Kruskal-Wallis Test, the result shows significantly statistical difference because of the p=0.00<0.01. It shows that the patients with low-grade pre-operational Hunt-Hess grading have better postsurgical outcome than the ones with high-grade grading, Grade I > Grade II > Grade III>Grade IV. 7. The relationship between the pre-operational CT scan and postsurgical outcome was analysed with Mann-Whitney Test, the result shows significantly statistical difference because of the p=0.00<0.01. It shows that the patients with intraventricular hemorrhage or intracerebral hematoma have poorer postsurgical outcome than the ones with simple subarachnoid hemorrhage(SAH). 8. The relationship between the aneurysm site observed intraoperatively and postsurgical outcome was analysed with Kruskal-Wallis Test, the result shows no statistical difference because of the p=0.385> 0.05. It shows that the aneurysm site has no direct relationship with the postsurgical outcome. 9. Therelationship between the aneurysm number and postsurgical outcome was analysed with Mann-Whitney Test, the result shows no statistical difference because of the p=0.577> 0.05. It shows that the aneurysm number has no direct relationship with the postsurgical outcome. 10. The relationship between the aneurysmal largest diameter and postsurgical outcome was analysed with Kruskal-Wallis Test, the result shows no statistical difference because of the p=0.479> 0.05. It shows that the aneurysmal largest diameter has no direct relationship with the postsurgical outcome. 11. The relationship between ventriculostomy or not and postsurgical outcome was analysed with Chi-Square Test, the result shows significantly statistical difference because of the p=0.001<0.01. It shows that the patients with ventriculostomy have poorer postsurgical outcome than the ones without ventriculostomy. 12. The relationship between the postsurgical consciousness or not and postsurgical outcome was analysed with Mann-Whitney Test, the result shows significantly statistical difference because of the p=0.000<0.01. It shows that the patients with postsurgical consciousness have better postsurgical outcome than the ones with postsurgical unnsciousness. 13. The relationship between the postsurgical paralysis or not and postsurgical outcome was analysed with Mann-Whitney Test, the result shows significantly statistical difference because of the p=0.000<0.01. It shows that the patients with postsurgical paralysis have poorer postsurgical outcome than the ones without postsurgical paralysis.CONCLUSIONS: 1. The patients’ sex, aneurysm site, aneurysm number and the aneurysmal largest diameter have no direct relationship with patients’ postsurgical outcome. 2. The postsurgical outcome is poor in old patients, espically in ones older than 60 years old. 3. The patients with more than one aneurysm rupture times have poorer postsurgical outcome than the ones with one aneurysm rupture times. The patients with long time interval between the last aneurysm rupture and the surgical operation have better postsurgical outcome than the ones with short time interval. 4.The patients with consciousness in admission have better postsurgical outcome than the ones with unconsciousness. 5.The patients with low-grade pre-operational Hunt-Hess grading have better postsurgical outcome than the ones with high-grade更多还原