颅内动脉瘤性蛛网膜下腔出血患者并发分流依赖性脑积水的影响因素分析  

Risk factors related to incidence of shunt dependent hydrocephalus in patients with intracranial aneurysmal subarachnoid hemorrhage

作　　者：余舰[1] 高歌[1] 张扬 晁迎九[1] 陈昱[1] 顾大群[1] 魏建军[1] 牛朝诗[1] 傅先明[1] Yu Jian;Gao Ge;Zhang Yang;Chao Yingjiu;Chen Yu;Gu Daqun;Wei Jianjun;Niu Chaoshi;Fu Xianming(Department of Neurosurgery, Anhui Provincial Hospital, Anhui Province Key Laboratory of Brain Function and Brain Disease, Anhui Provincial Stereotactic Neurosurgical Institute, Hefei 230001, China)

机构地区：[1]安徽省立医院神经外科、脑功能与脑疾病安徽省重点实验室、安徽省脑立体定向神经外科研究所,合肥230001

出　　处：《中华神经医学杂志》2018年第6期600-604,共5页Chinese Journal of Neuromedicine

基　　金：安徽省自然科学基金（1508085QH174）

摘　　要：目的分析颅内动脉瘤性蛛网膜下腔出血患者并发分流依赖性脑积水的相关危险因素，为临床诊疗决策提供指导。方法选择安徽省立医院神经外科自2013年1月至2016年12月收治的451例破裂颅内动脉瘤性蛛网膜下腔出血患者，其中发生分流依赖性脑积水67例．未发生分流依赖性脑积水384例。比较2组患者的临床资料，多因素Logistic回归分析患者发生分流依赖性脑积水的危险因素。结果与未发生分流依赖性脑积水组比较，发生分流依赖性脑积水组患者年龄〉60岁及有脑室内出血、后循环动脉瘤、急性脑积水和中枢神经系统感染者比例较高，差异有统计学意义（P〈0．05）。2组患者的Hunt-Hess分级、Fisher分级差异有统计学意义（P〈0．05）。多因素Logistic回归分析显示后循环动脉瘤、急性脑积水、中枢神经系统感染是颅内动脉瘤性蛛网膜下腔出I缸患者发生分流依赖性脑积水的独立危险因素。结论后循环动脉瘤、合并急性脑积水和中枢神经系统感染的动脉瘤性蛛网膜下腔出血患者的分流依赖性脑积水发生率较高。Objective To analyze the risk factors related to incidence of shunt dependent hydrocephalus in patients with intracranial aneurysmal subarachnoid hemorrhage so as to provide guidance for clinical diagnosis and treatment. Methods The clinical data were retrospectively analyzed of the 451 patients who had been treated in our hospital for ruptured intracranial aneurysmal subarachnoid hemorrhage from January 2013 to December 2016. Of them, 67 were complicated with shunt dependent hydrocephalus and 384 were not. The 2 groups were compared in terms of related clinical variables. Multivariate Logistic regression was conducted to analyze risk factors associated with incidence of shunt dependent hydrocephalus. Results The proportions of patients 〉60 years old, intraventricular hemorrhage, posterior circulation aneurysm, acute hydrocephalus and central nervous system infection were significantly higher in the patients with complicated shunt dependent hydrocephalus than in those without （P〈0.05）. There were significant differences between the 2 groups in Hunt-Hess grade and Fisher grade at admission （P〈0.05）. Multivariate Logistic regression analysis revealed that posterior circulation aneurysm, acute hydrocephalus and central nervous system infection were independent risk factors for incidence of shunt dependent hydrocephalus in patients with intracranial aneurysmal subarachnoid hemorrhage. Conclusion If the patients with intracranial aneurysmal subarachnoid hemorrhage are complicated with posterior circulation aneurysm, acute hydrocephalus and central nervous system infection, they are more likely to develop shunt dependent hydrocephalus.

关 键 词：颅内动脉瘤 蛛网膜下腔出血 分流依赖性脑积水 影响因素 

分 类 号：R743[医药卫生—神经病学与精神病学]