颅内压波形参数对动脉瘤性蛛网膜下腔出血术后大脑半球肿胀的预测价值  

Predictive values of parameters of intracranial pressure wave for postoperative global cerebral edema in patients with aneurysmal subarachnoid hemorrhage

作　　者：李辉[1,2] 黄志坚 刘国静[1] 漆凌骏 谢轩贵 孙晓川[1] Li Hui;Huang Zhijian;Liu Guojing;Qi Lingjun;Xie Xuangui;Sun Xiaochuan(Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Neurosurgery,the First People Hospital of Chengdu,Chengdu 610041,China)

机构地区：[1]重庆医科大学附属第一医院神经外科,400016 [2]成都市第一人民医院神经外科,610041

出　　处：《中华神经外科杂志》2019年第10期1031-1035,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81571159);国家临床重点专科建设项目[(2011)170]。

摘　　要：目的探讨动脉瘤性蛛网膜下腔出血(aSAH)患者术后的颅内压波形参数与大脑半球肿胀(GCE)发生的关系,为临床早期识别和干预GCE提供依据。方法回顾性分析2017年5月至12月重庆医科大学附属第一医院神经外科收治的80例aSAH患者的临床资料。所有患者均于行颅内动脉瘤夹闭术后3 d记录其颅内压波形参数。根据术后是否发生GCE将aSAH患者分为GCE组(13例)和非GCE组(67例),比较两组间的临床资料和颅内压参数的差异。采用多因素logistic回归分析探讨aSAH患者术后GCE发生的危险因素,应用受试者工作特征曲线(ROC)评价颅内压波形参数对aSAH术后GCE发生的预测价值。结果两组术前改良Fisher(mFisher)分级、颅内压波幅(MWA)、颅内压波幅与颅内压力的相关系数(RAP)的差异均有统计学意义(P值分别为0.012、0.005、0.001)。多因素logistic回归分析显示,mFisher分级(OR=8.896,95%CI:1.678~47.165,P=0.010)和RAP(OR=2.130,95%CI:1.155~3.931,P=0.016)为aSAH患者术后GCE发生的独立危险因素。ROC分析结果显示,MWA、RAP诊断GCE发生的最佳诊断界值分别为3.853、0.480,MWA对应的灵敏度和特异度分别为84.6%和70.1%、RAP分别为92.3%和74.6%。结论aSAH患者的术前mFisher分级、术后MWA和RAP可能与术后GCE的发生有关,mFisher分级和RAP为术后GCE发生的独立危险因素。临床动态监测MWA、RAP有助于早期预测GCE的发生。Objective To investigate the correlation between the parameters of intracranial pressure(ICP)wave and global cerebral edema for providing basis of early prediction and intervention for global cerebral edema after operation in patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 80 patients with aSAH admitted to Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University from May 2017 to December 2017 were retrospectively enrolled.The parameters of ICP wave and clinical data of 80 patients within 3 days after intracranial aneurysm clipping were collected and analyzed.The aSAH patients were divided into the global cerebral endema(GCE)group(n=13)and NO-GCE group(n=67)to compare the clinical data and parameters of ICP wave.The multivariate logistic regression analysis was used to determine the risk factors that might lead to GCE.According to receiver operating characteristic(ROC)curve,diagnostic threshold values for GCE were evaluated and sensitivity and specificity were calculated for optimal thresholds to investigate the predictive value of parameters of intracranial pressure wave for postoperative GCE.Results The difference of mFisher(modified Fisher)grading,mean ICP wave amplitude(MWA)and R-symbol of correlation between amplitude and pressure(RAP)were significant between NO-GCE group and GCE group(P value:0.012,0.005,0.001,respectively).The result of multivariate logistic regression analysis showed that mFisher grading(OR=8.896,95%CI:1.678-47.165,P=0.010),RAP(OR=2.130,95%CI:1.155-3.931,P=0.016)were independent risk factors of postoperative GCE.The optimal threshold values of MWA and RAP were 3.853 and 0.480 respectively,which had high diagnostic value in prediction of GCE.The relevant sensitivity and specificity were 84.6%and 70.1%for MWA and 92.3%and 74.6%for RAP.Conclusions The mFisher grading,MWA and RAP might be related to postoperative GCE in patients with aSAH.The mFisher grading and RAP are independent risk factors of postoperative GCE in patients with aSAH

关 键 词：颅内动脉瘤 蛛网膜下腔出血 颅内压 大脑半球肿胀 预测价值 

分 类 号：R74[医药卫生—神经病学与精神病学]