高分级动脉瘤性蛛网膜下腔出血手术治疗患者预后不良的影响因素分析  

Risk factors influencing prognosis in surgical patients with poor-grade aneurysmal subarachnoid hemorrhage

作　　者：余金辉 朱继[1] 何朝晖[1] 张晓冬[1] 徐丹[1] 郭宗铎[1] 杨小敏[1] 孙晓川[1] Yu Jinhui;Zhu Ji;He Zhaohui;Zhang Xiaodong;Xu Dan;Guo Zongduo;Yang Xiaomin;Sun Xiaochuan(Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第一医院神经外科

出　　处：《中国脑血管病杂志》2019年第6期288-295,共8页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(81571159)

摘　　要：目的探讨高分级动脉瘤性蛛网膜下腔出血(aSAH)患者手术治疗预后不良的影响因素。方法回顾性连续纳入2015年1月至2017年12月重庆医科大学附属第一医院神经外科高分级[世界神经外科联盟(WFNS)分级Ⅳ~Ⅴ级]aSAH住院患者142例,均经头部CT确诊为自发性蛛网膜下腔出血,且经头部CT血管成像或DSA确诊为颅内责任动脉瘤。根据治疗方式的不同,将142例分为手术治疗组(65例)和保守治疗组(77例)。记录两组患者的基线资料、临床资料、伴随症状及并发症,并进行组间比较。基线资料包括性别、年龄、吸烟史、饮酒史、高血压病、糖尿病;临床资料包括WFNS分级、Fisher分级、瞳孔变化、脑内血肿、脑室内积血、动脉瘤位置、动脉瘤直径;aSAH伴随症状包括院内再出血、症状性血管痉挛、症状性脑积水、癫痫、肺部感染;治疗相关并发症包括院外再出血、脑梗死、颅内感染。对手术治疗组患者进行预后良好及预后不良的单因素分析,并对其预后不良进行多因素Logistic回归分析。结果(1)手术治疗组年龄、脑室积血比例均小于保守治疗组,组间差异均有统计学意义[(54±9)岁比(60±12)岁,t=2.947;55.4%(36/65)比77.9%(60/77),χ^2=8.175;均P<0.01];其余基线资料、临床资料的差异均无统计学意义(均P>0.05)。(2)两组院内动脉瘤再破裂出血、症状性血管痉挛、症状性脑积水、癫痫及肺部感染的差异均无统计学意义(均P>0.05);手术治疗组未并发院外再出血,保守治疗组院外再出血发生率13.0%(10/77),组间差异有统计学意义(P<0.01);手术治疗组脑梗死及颅内感染发生率均高于保守治疗组[47.7%(31/65)比19.5%(15/77),χ^2=12.809;16.9%(11/65)比1.3%(1/77),χ^2=11.122],组间差异均有统计学意义(均P<0.01)。(3)手术治疗组预后良好率高于保守治疗组,病死率低于保守治疗组,组间差异均有统计学意义[预后良好率:60.0%(39/65)比26.0%(20/77),χ^2=1Objective To investigate risk factors affecting prognosis in patients with poor-grade aneurysmal subarachnoid hemorrhage(aSAH) underwent surgical intervention.Methods From January 2015 to December 2017,142 hospitalized patients with poor-grade (World Federation of Neurosurgery [WFNS]grade Ⅳ-Ⅴ) aSAH were consecutively and retrospectively enrolled in the Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University.All patients were diagnosed as spontaneous subarachnoid hemorrhage by head CT with intracranial aneurysm confirmed by CT angiography(CTA) or DSA.According to different therapeutic interventions,142 cases were divided into the surgical treatment group (65 cases) and the conservative treatment group (77 cases).Baseline demographics,clinical data,concomitant symptoms and complications were recorded and compared between groups.Baseline demographics included sex,age,smoking history,drinking history,hypertension and diabetes mellitus;clinical data included WFNS classification,Fisher classification,pupil changes,intracerebral hematoma,intraventricular hemorrhage,aneurysm location,aneurysm diameter;concomitant symptoms of aSAH included in-hospital rebleeding,symptomatic vasospasm,symptomatic hydrocephalus,epilepsy,pulmonary infection;treatment-related complications included recurrent bleeding after discharge,cerebral infarction and intracranial infection.Risk factors affecting prognosis in surgical patients were determined using univariate analysis and multivariate Logistic regression analysis.Results (1) Lower age and proportion of ventricular hematoma were found in the surgical treatment group than the conservative treatment group,and the differences were statistically significant([54±9] years old vs.[60±12] years old,t= 2.947;55.4%[36/65] vs.77.9%[60/77],χ^2=8.175;all P <0.01).There was no significant difference in other baseline demographics and clinical data (all P >0.05).(2) In the terms of aneurysm re-rupture,symptomatic vasospasm,symptomatic hydrocephalus,epilepsy and pu

关 键 词：蛛网膜下腔出血 动脉瘤 破裂 高分级 预后 

分 类 号：R651.1[医药卫生—外科学]