脑血管痉挛对动脉瘤性蛛网膜下腔出血 患者认知水平的影响

Effect of cerebral vascular spasm on cognitive level of patients with aneurysmal subarachnoid hemorrhage

摘要:

目的 探讨脑血管痉挛（CVS）对动脉瘤性蛛网膜下腔出血（aSAH）患者认知水平的影响。方法 选取2014 年1 月-2016 年12 月该院收治的98 例aSAH 患者作为研究对象。根据经颅多普勒检查结果将其分 为CVS 组（44 例）和非CVS（54 例）组；根据发病2 个月后的蒙特利尔认知评估量表（MoCA）评分又将 其分为认知功能障碍组（32 例）和认知功能正常组（66 例）。比较CVS 组和非CVS 组MoCA 评分结果和认 知功能障碍发生率，并比较认知功能障碍组和正常组的临床资料，采用多因素Logistic 回归分析探讨患者认知 功能障碍的影响因素。结果 98 例患者共有44 例合并CVS，发生率为44.9%。CVS 组MoCA 视空间与执行功能、 抽象、延迟回忆、定向的评分及总分低于非CVS 组，认知功能障碍发生率高于非CVS 组（P <0.05）；认知功 能障碍组入院时的GCS 评分低于正常组，Fisher 分级≥ 3 级、Hunt-Hess 分级≥ 3 级及出院时格拉斯哥评分 （GOS）为3、4 分高于认知功能正常组（P <0.05）。多因素Logistic 回归分析结果表明，CVS、Hunt-Hess 分 级≥ 3 级及出院时GOS 为3、4 分是患者出现认知功能障碍的危险因素（P <0.05）。结论 CVS 是aSAH 患者 的常见并发症，其增加患者认知功能障碍的发生风险。

Abstract:

Objective To investigate the effect of cerebral vascular spasm (CVS) on the cognitive level of patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods Totally 98 patients with aSAH from January 2014 to December 2016 were enrolled for the study. They were divided into CVS group and non-CVS group according to transcranial Doppler, and cognitive impairment group and normal group according to Montreal cognitive assessment scale (MoCA) score after 2 months of onset. MoCA score and the incidence of cognitive dysfunction were compared between CVS group and non-CVS group. Clinical data were compared between cognitive impairment group and normal group. Multivariate logistic regression analysis was used to investigate the independent related factors of patients with cognitive dysfunction. Results Actually 44 patients were combined with CVS in a total of 98 patients, whose rate was 44.9%. MoCA visual space and executive function, abstraction, delayed recall, orientation score and total score in CVS group were significantly lower than those of non-CVS group, the incidence of cognitive dysfunction was significantly higher than that in non-CVS group (P < 0.05). The GCS score at admission in cognitive dysfunction group was significantly lower than that in normal group, the rate of Fisher grade ≥ 3, Hunt-Hess grade level ≥ 3 and GOS score with 3 or 4 points at discharge were significantly higher than that in normal group, respectivelly (P < 0.05). Multivariate logistic regression analysis showed that CVS, Hunt-Hess grade level ≥ 3 and GOS score with 3 or 4 points were independent risk factors for cognitive impairment (P < 0.05). Conclusions CVS is a common complication of aSAH, and it can significantly increase the risk of cognitive impairment.