脑脊液引流速度对蛛网膜下腔出血患者血清CRP水平的影响及其预后相关性  

Effect of cerebrospinal fluid drainage rate on serum CRP level in patients with subarachnoid hemorrhage and its correlation with prognosis

作　　者：李宝嘉 莫泉 周秀传 梁才干 LI Bao-jia;MO Quan;ZHOU Xiu-chuan;LIANG Cai-gan(Department of Neurosurgery, Huaiji County People's Hospital, Zhaoqing 526400, Guangdong, CHINA)

机构地区：[1]怀集县人民医院神经外科,广东肇庆526400

出　　处：《海南医学》2018年第23期3289-3292,共4页Hainan Medical Journal

基　　金：广东省肇庆市科技创新指导项目(编号:2016040307)

摘　　要：目的探讨脑脊液引流速度对蛛网膜下腔出血(SAH)患者血清C反应蛋白(CRP)水平的影响及其与预后的关系。方法采用随机数表法,将2016年4月至2018年8月怀集县人民医院神经外科收治的311例SAH患者分为Ⅰ组(103例)、Ⅱ组(104例)、Ⅲ组(104例),三组患者均行腰大池持续引流(LCFD)术,脑脊液引流速度分别为5 mL/h、10 mL/h、15 mL/h,比较三组患者术前和术后1 d、3 d的血清CRP水平和预后情况,并对影响患者预后的因素做单因素和多因素分析。结果三组患者术后1 d、3 d的血清CRP水平均低于术前,术后3 d高于术后1 d,差异均有统计学意义(P<0.05);Ⅱ组、Ⅲ组患者术后1 d、3 d的血清CRP水平均低于Ⅰ组,Ⅱ组术后1 d、3 d的血清CRP水平低于Ⅲ组,差异均有统计学意义(P<0.05);三组患者术后3 d预后情况不同,Ⅱ、Ⅲ组优于Ⅰ组,Ⅱ组优于Ⅲ组,差异均有统计学意义(P<0.05);单因素分析结果显示,Hunt-Hess分级、引流速度及血清CRP水平是影响SAH患者预后的危险因素(P<0.05);多因素Logistic回归分析显示,Hunt-Hess分级、术后1 d和术后3 d血清CRP水平是影响SAH患者预后的独立危险因素(P<0.05);术后3 d血清CRP水平预测SAH患者预后不良的曲线下面积(AUC)为0.761,大于术后1 d的0.641,预测价值更好。结论脑脊液引流速度10 mL/h对SAH患者术后血清CRP水平负性影响较小,更有助于改善患者预后,血清CRP水平可作为患者预后不良的预测指标。Objective To explore the effect of cerebrospinal fluid drainage rate on serum C-reactive protein (CRP) levels in patients with subarachnoid hemorrhage (SAH) and its relationship with prognosis. Methods A total of 311 patients with SAH treated in the Department of Neurosurgery at the Huaiji County People's Hospital from April 2016 to August 2018 were divided into group Ⅰ (103 cases), group Ⅱ (104 cases) and group Ⅲ (104 cases) according to the random number table method. Three groups of patients were given continuous lumbar cerebrospinal fluid drainage (LCFD), and the cerebrospinal fluid drainage rates were 5 mL/h, 10 mL/h and 15 mL/h, respectively. The serum CRP levels and prognosis of the three groups were compared before operation and at 1 day and 3 days after operation, and the factors affecting the prognosis of patients were analyzed by univariate and multivariate analysis. Results The levels of serum CRP in the three groups at 1 day and 3 days after operation were lower than those before operation, and the level at 3 d after operation was higher than that at 1d after operation (P<0.05). The serum CRP levels in group Ⅱ and group Ⅲ at 1 d and 3 d after operation were lower than those in group Ⅰ, and the serum CRP levels in group Ⅱ at 1 d and 3 d after operation were lower than those in group Ⅲ (P<0.05). The prognosis of the three groups was different at 3 days after operation. The prognosis in group Ⅱ and group Ⅲ was better than that in group Ⅰ, and the prognosis in group Ⅱ was better than that in group Ⅲ (P<0.05). Univariate analysis results showed that Hunt-Hess classification, drainage rate and serum CRP levels were risk factors affecting the prognosis of SAH patients (P<0.05). Multivariate logistic regression analysis showed that Hunt-Hess classification and serum CRP level at 1d and 3 d after operation were independent risk factors for the prognosis of patients with SAH (P<0.05). The area under the curve (AUC) of serum CRP levels at 3 d after operation was 0.761 in predicting the

关 键 词：蛛网膜下腔出血 腰大池持续引流 引流速度 C反应蛋白 预后 

分 类 号：R743.35[医药卫生—神经病学与精神病学]