Risk Factors Analysis and Prevention of Cerebral Vasospasm after Interventional Treatment of Intracranial Ruptured Aneurysm in Elderly Patients

ZHANG Chang-wei; WANG Chao-hua; XU Ding

doi:10.3969/j.issn.1002-3429.2017.07.022

Abstract：Objective To analyze the risk factors of cerebral vasospasm after interventional treatment of intracranial rupture in elderly patients, and to explore the prevention and treatment of cerebral vasospasm in patients with ruptured intracranial aneurysms in the perioperative period.Methods January 2011-December 2015 months in our hospital senile ruptured intracranial aneurysm after interventional operation of cerebral vasospasm in 54 cases of the observation group, were randomly selected for the intervention of elderly patients of ruptured intracranial aneurysms after cerebral vasospasm in 60 cases as control group, compared two groups of clinical characteristics, postoperative medical factors.There were significant differences in the indexes by Logistic regression analysis, the risk factors of cerebral vasospasm after screening.Two groups of patients were followed up for at least 3 months, and the prognosis was observed.At the same time to explore the prevention and treatment of cerebral vasospasm.Results Univariate analysis showed that the aneurysm size, for the first time the severity of bleeding and postoperative blood pressure control, smoking and drinking, pseudoaneurysm or false aneurysm cavity, preoperative aneurysm rupture times, preoperative Fisher classification, interventional operation time, preoperative GCS score, postoperative use of "3H" therapy Hunt, PAASH grade, Hess classification, aneurysm embolization degree of the two groups had significant difference.Multivariate Logistic analysis showed that the aneurysm and 15 mm, postoperative blood pressure fluctuations, 30 mmHg, aneurysm rupture, preoperative 2, Hunt Hess, grade Ⅲ, grade level Fisher=3, non dense embolism, pseudoaneurysm is a risk of cerebral vasospasm factors in elderly patients with ruptured intracranial aneurysm after interventional treatment, early (within 72 h) embolization, the use of "3H" after therapy is a protective factor.The patients in the observation group after 3 months GOS outcome scale.Results: 20 cases of grade I, grade Ⅱ in 7 cases, 12 cases of grade Ⅲ, Ⅳ in 11 cases, 4 cases of grade V, the control group of 5 cases, 6 cases of grade Ⅱ, 21 cases of grade IⅡ, Ⅳ in 18 cases, 15 cases V, the observation group prognosis is worse than that of control group (P<0.05).Conclusion Elderly patients with ruptured intracranial aneurysm after surgical intervention of cerebral vasospasm, the overall poor prognosis and high mortality, according to the risk of cerebral vasospasm factors in elderly patients with ruptured intracranial aneurysm after interventional deterioration of protective factors, the implementation of good control of the controllable factors to improve the prognosis of patients.