Multivariate Analysis Of Central Diabetes Insipidus After Anterior Communicating Aneurysm Clippers

Objective:Through screening and summarizing a large number of clinical cases,to explore the related factors that affect the central diabetes insipidus(CDI)after anterior communicating aneurysm(ACOA)clipping,and then to explore the pathogenesis of CDI after anterior communicating aneurysm clipping,so as to guide clinical diagnosis and treatment to ACOA.Materials and Methods:A retrospective analysis was made of 154 patients who underwent craniotomy microclipping of anterior communicating aneurysms in neurosurgery department,Wuhan Central Hospital from January 2009 to January 2018(including 13 patients complicated with CDI after aneurysm clipping).There were 61 males and 93 females,aged from 33 to 76 years(mean 56.41±8.71 years),of which 5 cases of patients with anterior communicating artery aneurysm(ACOA)were routinely underwent computed tomography angiography(CTA)for accidental findings,the initial diagnosis of other patients was subarachnoid hemorrhage(SAH),and the diagnostic criteria were first inferred by high-quality(such as no motion artifacts,etc.)and non-enhanced high-resolution CT,and then ACOA was determined by CTA or Digital Subtraction Angiography(DSA).Research Methods:Different in selected patients with aneurysm anatomy(aneurysm diameter and pointing),preoperative difference(preoperative Hunt-Hess classification and grade of Fisher,clear preoperative hypertension,surgical timing),intraoperative situation(temporary blocking time,aneurysm rupture,presence of gettering straight gyrus,with or without exact in vascular injury and diffuse brain swelling),postoperative diabetes insipidus(happening,CT have clear new infarction),etc.According to the postoperative complications of CDI,the selected data were divided into"non-CDI group(141 cases)"and"CDI group(13cases)".SPSS 25.0 software was used for statistical analysis.The enumeration data were expressed as a percentage and tested withχ~2.The measurement data were expressed as(x~-±s),and two independent samples were used for t test.Factors affecting the occurrence of CDI after ACOA clipping were analyzed,and multivariate logistic regression analysis was used to determine the test level,p=0.05.Results:In the single-factor analysis,the differences between the CDI group and the non-cdi group were statistically significant(P<0.05)in all the included criteria,including definit postoperative new infarcts,aneurysm tip pointing,intraoperative temporary blocking time,preoperative Hunt-Hess grading,aneurysm top pointing and other factors(P<0.05),which affected the important factors of secondary CDI after ACOA clipping.The results of multivariate logistic regression analysis only supported that intraoperative aneurysm rupture was an independent risk factor for secondary CDI after ACOA clipping.Conclusion:ACOA secondary CDI after clipping and patients’gender,age,aneurysm size,,preoperative Hunt-Hess classification,preoperative Fisher clear classification,preoperative hypertension,surgical timing,intraoperative gettering straight gyrus,intraoperative temporary blocking time,intraoperative exact perforators vascular injury,diffuse brain swelling and postoperative CT exact new cerebral infarction has no ralationship,and intraoperative aneurysm rupture is the independent risk factors for the development of secondary CDI after ACOA clipping,so reduce intraoperative aneurysm rupture risk helps to avoid the occurrence of postoperative CDI.