动脉瘤性蛛网膜下腔出血后迟发性脑缺血的危险因素及预后研究

Study of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

摘要:

目的探讨动脉瘤性蛛网膜下腔出血后迟发性脑缺血的危险因素及预后。方法选择该院动脉瘤性蛛网膜下腔出血后迟发性脑缺血患者60 例作为迟发性脑缺血组，动脉瘤性蛛网膜下腔出血后无迟发性脑缺血患者210 例作为无迟发性脑缺血组。收集两组患者的临床资料。结果迟发性脑缺血组与无迟发性脑缺血组的脑水肿、手术时机、动脉瘤位置、WFNS 分级、Hunt-Hess 分级、改良Fisher分级、低白蛋白血症、低血红蛋白、低钠血症比较，差异有统计学意义（P <0.05），两组性别、年龄、糖尿病、高血压比较，差异无统计学意义（P >0.05）。Logistic 多因素回归分析显示，WFNS 分级≥Ⅳ级、Hunt-Hess 分级≥Ⅲ级、改良Fisher 分级≥Ⅲ级、低白蛋白血症、低钠血症是动脉瘤性蛛网膜下腔出血后迟发性脑缺血的独立危险因素（P <0.05）。迟发性脑缺血组与无迟发性脑缺血组预后比较，差异有统计学意义（ P<0.05），迟发性脑缺血组中度残疾+ 恢复良好率低于无迟发性脑缺血组，迟发性脑缺血组植物状态+ 重度残疾和死亡率高于无迟发性脑缺血组。结论WFNS 分级≥Ⅳ级、Hunt-Hess 分级≥Ⅲ级、改良Fisher 分级≥Ⅲ级、低白蛋白血症、低钠血症是动脉瘤性蛛网膜下腔出血后迟发性脑缺血的独立危险因素，动脉瘤性蛛网膜下腔出血后迟发性脑缺血患者的预后差。

Abstract:

Objective To investigate the risk factors and prognosis of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Methods Sixty patients with delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage were enrolled into delayed ischemic cerebral ischemia group, and 210 cases of patients without delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage were treated as nondelayed cerebral ischemia group in our hospital. The clinical data of both groups were collected. Results There were statistical differences in cerebral edema, timing of surgery, aneurysm position, WFNS grade, Hunt-Hess grade, improved Fisher grade, hypoalbuminemia, hypohemoglobinemia and hyponatremia between the delayed cerebral ischemia group and the non-delayed cerebral ischemia group (P < 0.05). There was no significant difference in gender, age, diabetes mellitus or hypertension between the two groups (P > 0.05). Logistic regression analysis showed that WFNS grade ≥Ⅳ, Hunt-Hess grade ≥Ⅲ, improved Fisher grade≥Ⅲ,hypoalbuminemia and hyponatremia were the independent risk factors of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage (P < 0.05). There was significant difference in prognosis between the delayed cerebral ischemia group and the non -delayed cerebral ischemia group (P < 0.05). The moderate disability plus recovery rate of the delayed cerebral ischemia group was lower than that of the non-delayed cerebral ischemia group. The rate of patients in vegetative state plus severe disability and the mortality in the delayed cerebral ischemia group were higher than those in the non -delayed cerebral ischemia group. Conclusions WFNS grade ≥Ⅳ, Hunt-Hess grade ≥Ⅲ, improved Fisher grade ≥Ⅲ, hypoalbuminemia and hyponatremia are the independent risk factors of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. The prognosis of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage is poor.