已破裂颅内动脉瘤住院期间再出血的临床分析  

Clinical analysis of rebleeding of ruptured aneurysms during the hospitalization

作　　者：郭烈美[1] 周洪语[1] 徐纪文[1] 王桂松[1] 田鑫[1] 王勇[1] 邱永明[1] 江基尧[1] 

机构地区：[1]上海交通大学医学院附属仁济医院神经外科,200127

出　　处：《中国脑血管病杂志》2010年第7期337-343,共7页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨已破裂颅内动脉瘤患者在住院期间发生再出血的时间、相关危险因素及预后。方法回顾性分析253例入院诊断为颅内动脉瘤破裂出血患者的病例资料，根据手术或介入治疗的时间分为早期干预组（0～3d）和晚期干预组（4～28d），再根据有无再出血分成两个亚组，并用统计学方法分析再出血与性别、年龄、动脉瘤的部位和大小、cT出血表现、Hunt—Hess评分、合并高血压及格拉斯哥预后（GOS）评分的关系。结果@253例已破裂动脉瘤患者中共有26例患者再出血，住院治疗期间再出血率为10．3％（26／253），其中早期干预组再出血率为5．2％（8／154），晚期干预组为18．2％（18／99），再出血的中位时间为6．5d。②早期干预组再出血和非再出血患者在年龄和是否合并高血压差异有统计学意义（P〈0．05）；晚期干预组再出血和非再出血患者在年龄和是否合并高血压差异无统计学意义（P〉0．05）。③早期和晚期干预组的再出血和非再出血患者在性别、动脉瘤部位和大小、CT出血表现、Hunt—Hess分级差异均无统计学意义（P〉0．05）。④早期和晚期干预组再出血与非再出血患者的GOS评分差异均有统计学意义（P〈0．05），再出血患者GOS评分明显低于非再出血患者。⑤全组再出血的病死率为13．8％（35／253），其中非出血组为10．1％（23／227），出血组为46．2％（12／26），两组之间差异有统计学意义（x2=25．499，P〈0．05）。其中早期组再出血的病死率为5／8，晚期组的病死率为7／18，但两组之间差异无统计学意义（x2=1．242，P〉0．05）。结论①已破裂动脉瘤晚期于预组再出血率明显高于早期干预组，提示早期手术或介入治疗能降低再出血率；②早期再出血与患者的年龄和合并高血压相关，高龄、合并高血压是早期再出血的危险因素；而晚期再出�Abstract： Objective To investigate the time of rebleeding, the related risk factors and the prognosis of rebleeding in patients with ruptured intraeranial aneurysms during the hospitalization. Methods The clinical data of 253 hospitalized patients with ruptured intracranial aneurysms were analyzed retrospectively. They were divided into an early intervention （0 to 3 days） group（ 154 patients） and late intervention （4 to 28 days） groups（99 patients） according to the time of surgical or endovaseular treat- ment. And then they were redivided into two subgroups according to whether they had rebleeding or not. Statistical methods were used to analyze the relationship between rebleeding and sex, age of the patients, site and size of the aneurysms, CT findings, Hunt-Hess grade, complicating hypertension, and the Glasgow Outcome Score （GOS）. Results （1）Of the 253 patients with ruptured intracranial aneurysms, 26 patients had rehleeding. The overall rebleeding rate was 10.3% （26/253） during hospitalization, 5.2% （8/154） in the early intervention group and 18.2% （18/99） in the late intervention group; The median time between the first and to rehleeding was 6.5 days. （2）There were significant differences in age and whether complicating hypertension or not between the patients with rebleeding and non-rebleeding in the early inter- vention group （ P 〈 0.05 ）. There were no significant differences in age and whether complicating hyperten- sion or not between the patients with rebleeding and non-rebleeding in the late intervention group （ P 〉 0. 05 ）. （3）There were no significant differences in patients sex and age, site and size of aneurysm, CT findings, and Hunt-Hess grade between the early intervention and late intervention groups in patients with rebleeding and non-rebleeding （ P 〉 0.05 ）. （4）There were significant differences in GOS among the whole group of patients, early intervention and late intervention groups, in patients with or without rebleeding（

关 键 词：颅内动脉瘤 动脉瘤 破裂 颅内出血 蛛网膜下腔出血 干预研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学]