影响重症动脉瘤性蛛网膜下腔出血预后因素的分析  

Therapeutic efficacy on patients with severe aneurysmal subarachnoid hemorrhage and factors affecting the prognosis

作　　者：何福亮[1,2] 张鸿祺[1] 李萌[1] 鲍遇海[1] 王宁[1] 张鹏[1] 支兴龙[1] 陈文劲[1] 谌燕飞[1] 何川[1] 叶明[1] 王亚冰[1] 徐跃峤[1] 程维涛[1] 凌锋[1] 

机构地区：[1]首都医科大学宣武医院神经外科,北京100053 [2]首都医科大学临床医学系2003级神经外科,100069

出　　处：《中国脑血管病杂志》2010年第8期411-415,共5页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨重症动脉瘤性蛛网膜下腔出血(aSAH)患者的临床疗效及影响预后的因素。方法回顾性分析74例入院时Hunt-HessⅣ、Ⅴ级aSAH患者的临床资料。其中Hunt-HessⅣ级51例,Ⅴ级23例;19例采用血管内栓塞动脉瘤,36例采用手术夹闭动脉瘤,19例采用保守治疗。出院后6个月随访患者的改良Rankin评分(mRS)。分析性别、年龄、Hunt-Hess分级、动脉瘤部位、治疗方式(手术或介入)、治疗距出血时问、是否早期解除颅内高压与患者mRS的关系。结果①74例中有5例失访。治疗后6个月随访到的69例患者中,预后良好率为28.9%(20/69),预后差发生率为5.7%(4/69),病死率为65.2%(45/69)。手术组+介入组的疗效优于保守治疗组,差异有统计学意义(P<0.05);Hunt-HessⅣ级患者的预后优于Ⅴ级患者,差异有统计学意义(P=0.039)。②多因素分析结果显示,患者入院的Hunt-Hess分级(OR=15.961,95% CI:1.556～163.676,P=0.020)和是否早期解除颅内高压(OR=19.741,95%CI:3.117～125.036,P=0.002)对预后的影响,差异有统计学意义;性别、年龄、动脉瘤部位、治疗方式及治疗距出血时间对患者预后的影响,差异无统计学意义(P>0.05)。结论患者入院的Hunt-Hess分级和是否及早解除颅内高压,是影响重症SAH患者预后的独立因素;对重症SAH患者应予以积极治疗,外科手段降低颅内压治疗可改善患者的预后。Objective To investigate the therapeutic efficacy and factors affecting the prognosis in patients with severe aneurismal subaraehnoid hemorrhage （aSAH）. Methods The clinical data of 74 patients with aSAH （Hunt-Hess grade IV and V on admission） were analyzed retrospectively. Among them, 51 were Hunt-Hess grade IV and 23 were grade V. The modified Rankin Scale （mRS） scores of the patients were followed up for 6 months after discharge. The relationship between the gender, age, Hunt- Hess grade, location of aneurysm, treatment modality （surgery or intervention） , time from onset to treatment, early relieving intracranial hypertension or not and the modified mRS scores of the patients were analyzed. Results （1）Five of the 74 patients were lost for follow up study. Among the 69 patients followed up for 6 months after the treatment, the rate of good prognosis was 28.9% （20/69）, the rate of poor prognosis was 5.7% （4/69）, and the mortality was 65.2% （45/69）. The prognosis of patients in the surgical group ＋ interventional group was superior to the untreated group, and the difference was statistically significant （ P 〈 0. 05 ） ; the prognosis of the patients with Hunt-Hess grade IV was better than those with grade V, and the difference was statistically significant （P = 0. 039 ）. （2）The results of multivariate analysis showed that the gender, age, location of aneurysm, treatment modality, and time from bleeding to treatment had no significant effects on the prognosis of the patients （ P 〉 0. 05 ） ; there were significant effects of the patients Hunt-Hess grading on admission （ OR = 15. 961, 95% CI： 1. 556 - 163. 676, P = 0. 0201 ） and early relieving intracranial hypertension or not （ OR = 19. 741,95% CI： 3. 117 - 125. 036, P =0.002） on the prognosis. Conclusions （1）Patients with Hunt-Hess grade on admission and early relieving intracranial hypertension or not are the independent factors affecting the prognosis of the patients with severe SAH. （2）Pa

关 键 词：蛛网膜下腔出血 颅内动脉瘤 治疗效果 预后 影响因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]