颅内动脉瘤破裂后脑室出血体积与预后的关系  

Association between volume of intraventricular hemorrhage and outcomes in patients with ruptured cerebral aneurysms

作　　者：陈川[1] 罗伦[1] 王辉[1] 李文胜[1] 郭英[1] 秦峰[1] 

机构地区：[1]中山大学附属第三医院神经外科,广州510630

出　　处：《中华神经医学杂志》2014年第3期282-287,共6页Chinese Journal of Neuromedicine

基　　金：广东省科技计划项目（20108060900023）

摘　　要：目的研究颅内动脉瘤破裂后脑室出血（IVH）体积与患者预后的关系。方法回顾性分析自2007年5月至2012年1月中山大学附属第三医院神经外科收治的符合入组标准的动脉瘤性蛛网膜下腔出血（aSAH）合并IVH患者的临床资料，采用1VH评分系统和SAH评分系统评估患者1VH体积和SAH总量评分，依据相关标准诊断迟发性脑缺血（OCt）的发生，应用起病6个月后随访时改良Rankin量表fmRS）分级评估预后（0-2级视为预后较好，3-6级视为预后较差）。采用单因素分析及多因素Logistic回归分析控制潜在的混杂因素，以明确IVH体积与患者预后的关系。结果共有129例患者符合条件人组，其中预后较好组75例（58．1％），预后较差组54例（41．9％）。单因素分析显示，预后较好组与预后较差组患者1VH体积[（5．69±5．08）mL vs（12．69±12．04）mE]比较差异有统计学意义（P〈0．05）。脑室出血量位于第四四分位的患者与位于第一四分位的患者相比，其预后明显较差fOIⅫ．800，95％CI：1．555～14．813，P=0．005）。多因素Logistic回归分析显示，IVH体积仍为预后不良的独立危险因素（oIPl．089，95％CI：1．012～1．173，P=0．023）。48例（37．2％）患者并发DCI，单因素分析显示1VH体积与DCI的发生相关（OR=1．050，95％CI：1．004～1．097，P=-0．033），但多因素Logistic回归分析显示其不是DCI发生的危险因素（OR=0．989，95％CI：0．927～1．044，辟0．693）。结论aSAH合并的IVH体积是患者预后不良的独立危险因素，但IVH并不是通过引发DCI来影响患者预后。Objective To assess the association between volume of intmventricular hemorrhage （WH） and outcomes in patients with ruptured cerebral aneurysms. Methods A retrospective analysis of the clinical data of patients with aneurysmal subarachnoid hemorrhage （aSAH） accompanied by IVH, admitted to our hospital from May 2007 to January 2012, was performed. The IVH scale and SAH scale systems were used to assess the 1VH volume and SAH sum, and delayed cerebral ischemia （DCI） was diagnosed in accordance with correlative standard. Outcomes at 6 months of follow-up were assessed using modified Rankin Scale （mRS, good outcome： 0-2; poor outcome： 3-6）. Univariate analyses and multiple logistic regression analyses were performed to assess the association between volume of 1VH and outcomes. Results A total of 129 patients met the criteria were enrolled; 75 patients（58.1%） had a good neurological outcome; significant difference in volume of intraventricular hemorrhage was noted between patients with good and poor neurological outcomes （5.69±5.08 mL vs. 12.69±12.04 mL, 19〈 0.05）; the outcomes of patients with IVH in the fourth quartile were worse than those in the first quartile （OR=4.800, 95%CI： 1.555-14.813, P=0.005）. In the multivariate analysis, the volume ofintraventricular hemorrhage was an independent predictor of poor outcomes （OR=1.089, 95%CI： 1.012-1.173, P=-0.023）.A total of 48 patients （37.2%） developed DCI after ictus; univariate analyses showed that 1VH volume was associated with onset of DCI （OR=1.050, 95%CI： 1.004-1.097, P=0.033）, but multiple Logistic regression analysis denied that （OP,=0.989, 95%CI： 0.927-1.044, P=-0.693）. Conelusion The volume of IVH is an independent predictor of poor outcomes in patients with aSAH; however, the pathophysiology of this association seems not to include inducing DCI.

关 键 词：颅内动脉瘤 脑室出血 蛛网膜下腔出血 迟发型脑缺血 预后 

分 类 号：R739.41[医药卫生—肿瘤]