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根据PHASES评分评估动脉瘤性蛛网膜下腔出血患者颅内动脉瘤破裂的风险。

Evaluation of the risk of rupture of intracranial aneurysms in patients with aneurysmal subarachnoid hemorrhage according to the PHASES score.

作者信息

Neyazi Belal, Sandalcioglu I Erol, Maslehaty Homajoun

机构信息

Department of Neurosurgery, Nordstadt Hospital Hannover, Haltenhoffstrasse 41, 30167, Hannover, Germany.

出版信息

Neurosurg Rev. 2019 Jun;42(2):489-492. doi: 10.1007/s10143-018-0989-2. Epub 2018 Jun 11.

Abstract

The PHASES score was developed to determine the risk of rupture of un-ruptured intracranial aneurysms (UIAs). The purposes of the current study were to apply this score on patients with actually ruptured intracranial aneurysms and to analyze the hypothetically prediction of the risk in this particularly patient group. We extracted the data of 100 recently treated patients (23 male, 77 female, mean age 56.4 years, range 17-93 years) with ruptured saccular intracranial aneurysms from our prospectively maintained neurovascular database according to the parameters used in the PHASES score (population, hypertension, age, earlier SAH, size and site of the aneurysm). Descriptive statistical analysis was performed using SPSS for Windows version 18.0 (SPSS Inc., Chicago, Illinois, USA). Ninety-nine percent of the patients were European and 1% Japanese in our series. Pre-existing arterial hypertension was found in 59%. Fifteen percent of the patients were > 75 years. Earlier SAH was found in 1%. The site of the aneurysms were the internal carotid artery (ICA) in 10%, the middle cerebral artery (MCA) in 14%, and arteries of the anterior and posterior circulation (PC) including the posterior communicating artery (PCOM) in 76%. Sixty-six percent of the aneurysms were smaller than 7 mm, 18% ranged between 7 and 9.9 mm, 14% were between 10 and 19.9 mm, and 2% were larger than 20 mm. European population, aneurysm size < 7 mm, and age < 75 years scored with 0 point in the PHASES study occurred most frequently in our series. The distribution of the aneurysm site to the anterior and posterior circulation scored with 4 points occurred most frequently. Considering the 5-year risk of rupture, 70% of our patient collective would have an estimated risk of < 2%. Interestingly, 70% of the patients with aneurysmal SAH had a low risk profile and would have a low risk of rupture according to the PHASES score in our series. This observation underlines the discrepancy of the estimated low risk of rupture for UIAs in young and healthy patients and the obvious fact the majority of the SAH patients are actually young with low risk factors. Parameters beyond the features of the PHASES score are needed to determine the risk of rupture of intracranial aneurysms.

摘要

PHASES评分用于确定未破裂颅内动脉瘤(UIA)的破裂风险。本研究的目的是将该评分应用于实际发生颅内动脉瘤破裂的患者,并分析该特定患者群体风险的假设性预测。我们根据PHASES评分中使用的参数(人群、高血压、年龄、既往蛛网膜下腔出血、动脉瘤大小和部位),从我们前瞻性维护的神经血管数据库中提取了100例近期接受治疗的囊状颅内动脉瘤破裂患者的数据(23例男性,77例女性,平均年龄56.4岁,范围17 - 93岁)。使用SPSS for Windows 18.0版本(SPSS公司,美国伊利诺伊州芝加哥)进行描述性统计分析。在我们的系列研究中,99%的患者为欧洲人,1%为日本人。59%的患者存在既往动脉高血压。15%的患者年龄大于75岁。1%的患者有既往蛛网膜下腔出血。动脉瘤部位为颈内动脉(ICA)的占10%,大脑中动脉(MCA)的占14%,包括后交通动脉(PCOM)在内的前循环和后循环(PC)动脉的占76%。66%的动脉瘤小于7mm,18%在7 - 9.9mm之间,14%在10 - 19.9mm之间,2%大于20mm。在我们的系列研究中,欧洲人群、动脉瘤大小<7mm且年龄<75岁在PHASES研究中得0分的情况最为常见。动脉瘤部位在前循环和后循环得4分的分布最为常见。考虑到5年破裂风险,我们的患者群体中有70%估计风险<2%。有趣的是,在我们的系列研究中,70%的动脉瘤性蛛网膜下腔出血患者风险特征较低,根据PHASES评分破裂风险较低。这一观察结果强调了年轻健康患者中UIA估计破裂风险较低与大多数蛛网膜下腔出血患者实际上年轻且风险因素较低这一明显事实之间的差异。需要PHASES评分特征以外的参数来确定颅内动脉瘤的破裂风险。

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