动脉瘤性蛛网膜下腔出血早期并发神经源性肺水肿的相关危险因素分析  

Analysis of the associated risk factors of patients with neurogenic pulmonary edema in the early stage of aneurismal subarachnoid hemorrhage

作　　者：李启明[1] 李瑾[1] 张均[1] 钱健[1] 顾双双[1] 王路娜[1] 沙杜鹃[1] 

机构地区：[1]南京大学医学院附属鼓楼医院,南京210008

出　　处：《内科急危重症杂志》2016年第3期187-189,共3页Journal of Critical Care In Internal Medicine

摘　　要：目的：分析动脉瘤性蛛网膜下腔出血（SAH）早期并发神经源性肺水肿（NPE）患者的相关危险因素。方法：206例动脉瘤破裂蛛网膜下腔出血患者根据是否并发NPE分为NPE组（25例）和非NPE组（181例）,比较2组在年龄、性别、基础疾病、平均动脉压、心率、病情严重程度、动脉瘤在Willis动脉环所处位置、心电图异常等方面的差异。结果：NPE组与非NPE组在年龄、性别、基础疾病、平均动脉压、心率等方面没有差异（均P〉0.05）。与非NPE组相比,NPE组具有更高的Hunt-Hess分级、Fish分级和表现出更多的心电图异常（均P〈0.05）。当动脉瘤位于后循环时,NPE的发生率显著高于前循环（P〈0.05）。非特异性ST-T改变在NPE组的发生率更高（P〈0.05）。采用逐步logistic回归法发现Fish分级Ⅲ-Ⅳ级组、后循环动脉瘤及非特异性ST-T改变为NPE的危险因素（均P〈0.05）。结论：在SAH发病初期,CT评估的出血量、破裂动脉瘤的位置和非特异性ST-T心电图改变可能有助于预测并早期识别NPE的发生。Objective： To analyze the associated risk factors of patients with neurogenic pulmonary edema（ NPE） in the early stage of aneurismal subarachnoid hemorrhage（ SAH）. Methods： Two hundred and six patients with aneurismal subarachnoid hemorrhage were divided into NPE group（ 25 cases） and non-NPE group（ 181 cases）. Age,gender,prior comorbidity,mean arterial pressure,heart rate,the severity of the disease,the location of artery aneurysms in Willis arterial circle,and ECG abnormalities were compared between the two groups. Results： There were no significant differences in age,gender,prior comorbidity,mean arterial pressure and heart rate between the two groups（ all P〉0. 05）. Compared with those of non-NPE group,NPE group had a higher grade of Hunt-Hess and Fish grade and had more ECG abnormalities（ all P〈0. 05）. When the aneurysm was located in the posterior circulation,the incidence of NPE was significantly higher than that in the anterior circulation（ all P〈0. 05）. The incidence of nonspecific ST-T changes was significantly higher in the NPE group（ P〈0. 05）. The Fisher grade Ⅲ-Ⅳ,aneurysm located in posterior circulation and nonspecific ST-T changes were the independent factors for NPE by logistic regression analysis（ all P〈0. 05）. Conclusions： The volume of hemorrhage in CT,location of aneurysm and non-specific ST-or T-wave changes in ECG may had contribution to prediction and identifying the development of NPE in the early stage of SAH.

关 键 词：动脉瘤性蛛网膜下腔出血 神经源性肺水肿 心电图 

分 类 号：R743.35[医药卫生—神经病学与精神病学]