Analysis Of Risk Factors Of Acute Coagulation Dysfunction After Intracranial Ruptured Aneurysm Surgery

Objective:This article mainly analyzes the influencing factors of acute coagulation dysfunction after intracranial ruptured aneurysm surgery,and carries out early prevention and intervention for high-risk patients to reduce the possibility of acute coagulation dysfunction after surgery.Methods: After screening for inclusion criteria and exclusion criteria,110 patients with aneurysm clipping surgery and 140 patients with interventional embolization surgery were selected from neurosurgery,the Second Affiliated Hospital of Kunming Medical University from January 1,2019 to December 31,2022.Refer to the diagnostic criteria of coagulation dysfunction after craniocerebral injury and the diagnostic criteria of coagulation dysfunction in the national clinical laboratory operating procedures(the fourth edition),which are divided into normal group and abnormal group.32 factors that may be related to postoperative acute coagulation dysfunction were collected,including gender,age,smoking history,drinking history,hypertension history,diabetes history,coronary heart disease history,stroke history,atherosclerosis history,GCS score,Hunt Hess grade,modified Fisher grade,WFNS grade,neurological dysfunction at admission,operation time,operation duration,total intraoperative intake,intraoperative bleeding,and net intraoperative intake,Blood loss per unit time,intraoperative blood transfusion,intraoperative hemostat,ALT,AST,serum creatinine,plasma calcium concentration difference,preoperative antiepileptic drugs,preoperative hemostat,preoperative infection,aneurysm diameter,aneurysm aspect ratio(AR value),aneurysm location.Single factor analysis adopts R × C contingency table χ~2 Test,test level a=0.05.Multivariate analysis was conducted by using binary logistic regression analysis,and the test level was a=0.05.Results:Univariate analysis showed that there were 12 factors that might cause coagulation dysfunction after intracranial ruptured aneurysm surgery in the clipping group,including age,history of diabetes,GCS score,Hunt Hess grade,WFNS grade,neurological dysfunction at admission,preoperative use of antiepileptic drugs,preoperative use of hemostatic drugs,preoperative and postoperative plasma calcium concentration difference,operation time,operation duration,and intraoperative bleeding volume;The patients in the interventional embolization group had 7 factors that might cause coagulation dysfunction after operation of intracranial ruptured aneurysms,including age,modified Fisher grade,WFNS grade,preoperative use of antiepileptic drugs,aneurysm diameter,preoperative and postoperative plasma calcium concentration difference,and operation duration.Multivariate analysis showed that the age ≥ 65 years in the clipping group,the decrease of calcium concentration difference after operation,the operation time between 3 and 7 days after the onset,and the operation time>5 hours were the main influencing factors for the occurrence of acute coagulation dysfunction after the operation of intracranial ruptured aneurysms;Age ≥ 65 years old,aneurysm diameter>1 cm,decreased calcium ion concentration difference after operation,and operation time>5 hours in the interventional embolization group were the main factors affecting the occurrence of acute coagulation dysfunction after operation of intracranial ruptured aneurysm.Conclusion:1.For patients undergoing craniotomy and clipping,age ≥ 65 years old,postoperative calcium ion concentration is lower than that before operation,operation time is 3～7 days after onset,and operation duration>5 hours are the main influencing factors of postoperative acute coagulation dysfunction.2.For patients undergoing interventional embolization,age ≥ 65 years old,postoperative calcium ion concentration decreased compared with preoperative,operation duration>5 hours,aneurysm diameter>1 cm are the influencing factors of postoperative acute coagulation dysfunction.3.Therefore,to prevent the occurrence of acute coagulation dysfunction,for the elderly patients who have undergone craniotomy and clipping who have been treated within 3 to 7 days after the onset of the disease and for the elderly patients who have undergone interventional embolization and whose aneurysm diameter under imaging is greater than 1 cm,clinicians should strictly control the operation duration during the operation,supplement calcium ions in time after the operation.