人血白蛋白对蛛网膜下腔出血后脑血管痉挛、脑梗死及其预后的影响  

Influence of human serum albumin on cerebral vasospasm,cerebral infarction after subarachnoid hemorrhage and its outcome

作　　者：蒋苏莉[1] 程谦涛[1] 薛刘军[1] 夏磊[1] 李明超[1] 郭建一[1] 孙成梅[1] 

机构地区：[1]南京医科大学附属淮安第一医院神经内科,223300

出　　处：《临床神经病学杂志》2013年第6期442-444,共3页Journal of Clinical Neurology

摘　　要：目的探讨人血白蛋白治疗对蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)、脑梗死及其预后的影响。方法 192例SAH患者分为人血白蛋白治疗组100例和常规治疗组92例。两组均给予SAH常规治疗,白蛋白治疗组再给予25%人血白蛋白40 ml静脉滴注,每12 h 1次,连续7 d。发病2周内,通过临床表现及TCD、DSA诊断CVS,CT或MRI诊断脑梗死;统计发生应激性溃疡、肺部感染、再出血和脑积水的病例。发病3个月后,给患者进行改良Rankin量表(mRS)评分,mRS评分0～3分为预后良好,4～6分者为预后不良。对CVS、脑梗死与预后的关系进行Logistic回归分析。结果白蛋白治疗组临床表现、TCD、DSA诊断CVS的比率及脑梗死的发生率(分别为36.0%,52.0%,19.0%,15.0%)均显著低于常规治疗组(分别为54.1%,68.5%,31.5%,27.1%)(均P<0.05)。白蛋白治疗组预后良好的比率(74.0%)显著高于常规治疗组(58.7%)(P<0.05)。Logistic回归分析示,临床表现诊断CVS(OR=-2.954,95%CI:0.009～0.288)、DSA诊断CVS(OR=-2.771,95%CI:0.005～0.832)及发生脑梗死(OR=-2.896,95%CI:0.004～0.686)为SAH预后不良的影响因素(P<0.05～0.005)。两组并发应激性溃疡、肺部感染、再出血和脑积水的比率差异无统计学意义。结论静脉人血白蛋白治疗能降低SAH患者CVS及脑梗死的发生率,显著改善患者的预后。Objective To explore the influence of human serum albumin to cerebral vasospasm （CVS）, cerebra/ infaretlon after subarachnoid hemorrhage （SAH） and its outcome. Methods One hundred and ninety-two patients with SAH were randomly divided into the human serum albumin group （n = 100） and c.unventional treatment group （n = 92）. Two groups were given conventional treatment of SAH. The patients in albumin group were admitted to receive intravenous 25% human albumin of 40 ml,which was taken once every 12 h,for 7 d. Within 2 weeks after symptom onset,diagnosis of CVS were made according to the clinical manifestation,TCD and DSA;cerebral infarction were diagnosed with CT or MRI. The incidence of stress ulcer, pneumonia, rebleeding and hydrocephalus were evaluated. In addition,modified Rankin scale （mRS） scores were determined in patients 3 months ＇after subaraehnoid hemorrhage：good outcome defined as a score of 0 -3, poor outcome defined as a score of 4 -6. Logistic regression analysis was performed to determine the relationship between CVS,eerebral infarction and outcome. Results In the albumin group, The diagnostic rates of CVS by the clinical feature ,TCD and DSA and the incidcnce rates of cerebral infarction （36.0% ,52.0%, 19.0%, 15.0%, respectively）were obviously decreased than those in eonventional treatment group （54.1% ,68.5% ,31.5% ,27. 1%, respectively）（ all P 〈 0. 05 ）. Patients in the albumin group had more good outcome （74.0%） than in conventional treatment group（58.7% ）（ P 〈 0. 05 ）. Logistic analysis indicated that the incidence of CVS [ by symptomatic （ OR = - 2. 954,95% CI：0. 009 - 0. 288 ） and by DSA （ OR = - 2. 771, 95 % CI：0. 005 - 0. 832 ） criteria ] and the occurence of cerebral infarction （ OR = - 2. 896,95 % CI：0. 004 - 0. 686 ） were closely related to the poor outcomes. Conclusion Intravenous human serum albumin can reduce the incidence of CVS and cerebral infarction, can improvethe outcome after SAH.

关 键 词：蛛网膜下腔出血 人血白蛋白 脑血管痉挛 脑梗死 

分 类 号：R743.35[医药卫生—神经病学与精神病学]