动脉瘤性蛛网膜下腔出血患者腰大池引流减少脑积水发生影响因素分析  

Risk factors of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage

作　　者：邵军[1,2] 陈高[1] 胡华[1] 祝向东[1] 许璟[1] 王林[1] 王真[1] 胡强[1] 

机构地区：[1]浙江大学医学院附属第二医院神经外科,浙江杭州310009 [2]绍兴第二医院神经外科,浙江绍兴312000

出　　处：《浙江大学学报（医学版）》2014年第1期71-76,共6页Journal of Zhejiang University(Medical Sciences)

基　　金：国家自然科学基金(81171094);卫生部科学研究基金(WKJ2009-2-025)

摘　　要：目的:探讨影响腰大池引流降低动脉瘤性蛛网膜下腔出血(aSAH)后分流依赖性脑积水发生率的相关因素。方法:回顾性分析2011年1月至2013年1月在浙江大学医学院附属第二医院治疗的且在围手术期行腰大池引流的136例颅内动脉瘤患者资料,分析分流依赖性脑积水发生的相关因素。结果:23例患者(16.91%)发生分流依赖性脑积水。单因素分析显示以下因素可能与分流依赖性脑积水发生相关:入院时Hunt-Hess分级(P<0.01)和Fisher分级(P<0.01);脑室内出血(P<0.01);破裂动脉瘤部位(P=0.001);平均每日脑脊液引流量(P=0.047)。结论:aSAH患者入院时Hunt-Hess分级差、Fisher分级高、出现脑室内出血、后循环破裂动脉瘤,或者平均每日脑脊液引流量过多或过少,其分流依赖性脑积水发生率较高。Objective： To investigate risk factors for the occurrence of shunt- dependent hydrocephalus in patients with aneurysmal subarachnoid hemorrhage （aSAH）. Methods： A cohort of 136 consecutive patients who were treated for ruptured aneurysms within 72 h after onset of aSAH from January 2011 to January 2013 wereretrospectively analyzed. Lumbar drainage was performed during the surgery in all patients. The risk factors of shunt-dependent hydrocephalus were analyzed. Results： Of 136 patients, 23 （16. 91% ） underwent shunt operation to treat shunt-dependent hydrocephalus. Univariate analysis showed that Hunt-Hess grade at admission （P 〈 0. 01 ）, Fisher grade （ P 〈 0. 01 ）, the presence of intraventricular hemorrhage （ P 〈 0. 01 ） ,location of ruptured aneurysm （ P = 0. 001 ）, and the average daily volume of cerebrospinal fluid drainage （CSF） （P = 0.047） were associated with shunt-dependent hydrocephalus. Conclusion： The aSAH patients with poor Hunt-Hess grade at admission, high Fisher grade, the presence of intraventricular hemorrhage, ruptured aneurysm in posterior circulation, and abnormal average daily volume of CSF are more likely to develop shunt-depended hydrocephalus.

关 键 词：动脉瘤 颅内动脉瘤 并发症 脑积水 脑脊髓液分流术 腰骶部 蛛网膜下腔出血 统计学(主题) 回顾性研究 

分 类 号：R743.35[医药卫生—神经病学与精神病学]