动脉瘤性蛛网膜下腔出血早期预后的多因素分析  

Multivariate analysis of factors influencing early prognosis in the patients with aneurysmal subarachnoid hemorrhage

作　　者：钱进先[1] 李磊[2] 虞正权[2] 陆士奇[3] 汪利宗[3] 孙海伟[3] 

机构地区：[1]南京医科大学附属苏州市立医院北区ICU,江苏苏州215008 [2]苏州大学附属第一人民医院脑外科,江苏苏州215006 [3]苏州大学附属第一人民医院急诊科,江苏苏州215006

出　　处：《中国急救医学》2010年第4期297-300,共4页Chinese Journal of Critical Care Medicine

基　　金：江苏省医学重点人才基金资助项目（No.200728）（真挚地感谢上海市第六人民医院神经内科程晓娟博士对本课题提供的指导与帮助!）

摘　　要：目的探讨影响动脉瘤性蛛网膜下腔出血患者早期预后的危险因素。方法回顾性分析苏州大学附属第一人民医院脑外科2007～2009年收治的152例颅内动脉瘤性蛛网膜下腔出血患者的临床资料，分别对年龄、高血压、意识障碍史、Hunt—Hess分级、改良Fisher分级等23项危险因素进行单因素分析，并进行Loostic回归分析。结果单因素分析显示，Hunt—Hess分级、改良Fisher分级、格拉斯哥昏迷评分（GCS）、急性生理及慢性健康状况评分Ⅱ（APACHEⅡ）、简化急性生理学评分（SAPSⅡ）、脑血管痉挛、意识障碍史、高血压、年龄、白细胞计数、超敏c反应蛋白与预后有显著相关性（P〈0．01或P〈0．05）。多因素Logistic回归分析显示，改良Fisher分级[OR=19．51，95％可信区间（CI）1．84～206．73，P=0．014]、APACHEⅡ评分[OR=17．34，95％ CI 2．53～119．06，P=0．004]、脑血管痉挛[OR=27．84，95％CI 2．17～357．19，P=0．001]进入回归方程。结论改良Fisher分级、APACHEⅡ评分、脑血管痉挛是动脉瘤性蛛网膜下腔出血早期预后不良的独立危险因素。Objective To investigate the factors related to the prognosis in the patients with aneurysmal subarachnoid hemorrhage（aSAH）.Metheds The clinical data of 152 patients with aSAH, who were treated in the department of neurosrrrgery of our hospital from 2007 to 2009, were analyzed retrospectively. Univariate analysis was performed in age, hypertension, consciousness disorders, Hunt- Hess grade, modified Fisher grade and the other factors. Logistic multivariate analysis of the factors related to the prognosis was performed in the patients with aSAH. Resalts tn univariate analysis, Hunt - Hess grade, modified Fisher grade, GCS score, APACHE Ⅱ, SAPS Ⅱ, CVS, consciousness disorders, hypertension, age, white blood cell count and hs - CRP were relatod to prognosis（P 〈 0. 01 or P 〈 0. 05 ）. In Logistic multivariate analysis , modified Fisher grade （ OR = 19. 51,95% CI 1.84 - 206.73, P = 0. 014 ）, APACHE Ⅱ （ OR = 17.34,95% El 2.53 - 119.06, P = 0. 004） and CVS（OR =27.84,95%Cl 2.17 -357.19,P=0.001 ） entered equation. Conclusion The modified Fisher grade, APACHE Ⅱ and CVS are independent risk factors of aSAH for early prognosis.

关 键 词：蛛网膜下腔出血 动脉瘤 预后 多因素分析 

分 类 号：R743.35[医药卫生—神经病学与精神病学]