老年患者发生迟发性脑缺血前多种影响因素的探究

Risk factors for delayed cerebral ischemia in elderly patients

摘要:

目的  探究老年患者发生迟发性脑缺血（DCI）的危险因素，防止迟发性脑缺血的发生。方法  回顾性分析120例动脉瘤性蛛网膜下腔出血患者。年龄60～79岁，Fisher分级>1。将患者分为DCI组和非DCI组。分析患者的相关指标（性别、吸烟史、局部脑氧饱和度等），找出迟发性脑缺血的独立危险因素，并用受试者工作曲线评估其预测性能。结果  所有入组患者中，69例患者伴有DCI。单因素分析结果表明，DCI组患者中，有吸烟史、低钠、局部脑氧饱和度<50的患者比例明显大于非DCI组，差异有统计学意义（P <0.05）。多因素Logistic回归分析发现，钠离子浓度（■=3.011，95%CI：1.123，8.070）与局部脑氧饱和度（■=3.324，95%CI：1.734，6.372）是迟发性脑缺血的独立危险因素，且局部脑氧饱和度预测性能更佳。结论  局部脑氧饱和度是老年患者动脉瘤性蛛网膜下腔出血后迟发性脑缺血较好的预测指标。

Abstract:

Objective To explore the independent risk factors for delayed cerebral ischemia (DCI) in elderly patients so as to prevent occurrence of delayed cerebral ischemia. Methods Totally 120 subjects with aneurismal subarachnoid hemorrhage with the age of 60-79 years and Fisher grade >1 were included in the retrospective study. The patients were divided into DCI group and non-DCI group. The patient's relevant indicators (gender, smoking history, regional cerebral oxygen desaturation and so on) were analyzed to identify independent risk factors for delayed cerebral ischemia. Through ROC analysis their predicting value was evaluated. Results Among all subjects, 69 patients had DCI. Univariate analysis showed that the proportion of the patients with smoking history, low sodium and regional cerebral oxygen desaturation <50 in the DCI group was significantly higher than that in the non-DCI group (P < 0.05). Multivariate logistic regression analysis showed that sodium ion concentration (■ = 3.011; 95% CI: 1.123, 8.070) and regional cerebral oxygen saturation (■ = 3.324; 95% CI: 1.734, 6.372) were the independent risk factors for delayed cerebral ischemia. Regional cerebral oxygen saturation was a helpful predictor. Conclusions Regional cerebral oxygen saturation is a helpful predictor for delayed cerebral ischemia after aneurismal subarachnoid hemorrhage in elderly patients.