老年重症动脉瘤性蛛网膜下腔出血患者预后的影响因素分析  

Analysis of prognostic factors on elderly patients with severe aneurysmal subarachnoid hemorrhage

作　　者：齐猛[1] 曲鑫 徐跃峤[1] 陈文劲[1] 程玮涛[1] 王娜[1] 蒋丽丹[1] 王宁[1] Qi Meng;Qu Xin;Xu Yueqiao;Chen Wenjin;Cheng Weitao;Wang Na;Jiang Lidan;Wang Ning(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科

出　　处：《中国脑血管病杂志》2020年第1期11-16,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：北京市科技计划(Z151100004015095);北京市教育委员会科技计划、社科计划(KM201710025015);首都医科大学宣武医院基础临床研究项目(201709)

摘　　要：目的分析老年重症动脉瘤性蛛网膜下腔出血(aSAH)患者预后的影响因素。方法回顾性连续纳入2015年3月至2017年3月首都医科大学宣武医院神经外科重症监护室老年重症aSAH患者49例,年龄≥65岁,且Hunt-Hess分级Ⅲ~Ⅴ级,经头部CT诊断有蛛网膜下腔出血,经DSA或CT血管成像证实为单发颅内责任动脉瘤。患者均予以多模态监测基础上的集束化神经重症监护治疗,对颅内动脉瘤采用开颅夹闭或血管内介入治疗,动脉瘤处理后进行重症监护治疗。根据患者出院后30 d格拉斯哥预后量表分级结果评估预后,其中Ⅳ~Ⅴ级为预后良好,Ⅰ~Ⅲ级为预后不良,并分为预后良好组(17例)和预后不良组(32例)。记录两组患者的一般资料及并发症情况,并进行组间比较。一般资料包括性别、年龄、高血压病、糖尿病、冠心病、责任动脉瘤部位、Hunt-Hess分级;并发症包括脑血管痉挛、新发脑梗死、肺部感染、肝功能异常、低蛋白血症、贫血和电解质紊乱(钠或钾离子异常)。对老年重症aSAH患者进行预后良好与预后不良的单因素分析,并对其预后不良的影响因素进行多因素Logistic回归分析。结果(1)49例患者住院时间为9~40 d,平均(17±7)d;住院期间死亡2例,存活的47例患者均获得随访,随访期间死亡1例,病死率为6.1%(3/49);脑血管痉挛发生率为38.8%(19/49),新发脑梗死发生率为24.5%(12/49),肺部感染发生率为67.3%(33/49),肝功能异常发生率为22.4%(11/49),低蛋白血症发生率49.0%(24/49),贫血发生率为53.1%(26/49),电解质紊乱发生率83.7%(41/49)。(2)两组患者年龄、性别、高血压病、糖尿病、冠心病、责任动脉瘤部位和动脉瘤处理方式的差异均无统计学意义(均P>0.05);预后良好组Hunt-Hess分级Ⅲ、Ⅳ、Ⅴ级分别为11、5、1例,预后不良组Hunt-Hess分级Ⅲ、Ⅳ、Ⅴ级分别为3、21、8例,两组不同程度Hunt-Hess分级的差异有统计学意义(Z=13.749,P<0.01Objective To analyze the prognostic factors affecting elderly patients with severe aneurysmal subarachnoid hemorrhage.Methods From March 2015 to March 2017,49 consecutively aged above 65 yrs cases of severe aneurysmal subarachnoid hemorrhage(Hunt-Hess GradeⅢ-Ⅴ)diagnosed according to head CT and intracranial ruptured aneurysm confirmed by DSA or CT angiography(CTA)and admitted at Neurosurgical critical care unit of Xuanwu Hospital,Capital Medical University were retrospectively included.Bundle critical care methods were applied based on multi-modality monitoring,and intracranial aneurysm was obliterated by surgical clipping or endovascular intervention followed by neurocritical care and management.Follow up was performed 30 d after discharge by recording Glasgow Outcome Scale(GOS),within whichⅠ-Ⅲas unfavorable outcome(n=32)andⅣ-Ⅴas favorable outcome(n=17).The general information and complications of patients in both groups were recorded and compared between groups.General information includes gender,age,hypertension,diabetes,coronary atherosclerotic heart disease,location of ruptured aneurysm and Hunt-Hess grade;complications includes cerebral vasospasm,new cerebral infarction,pulmonary infection,hepatic dysfunction,hypoalbuminemia,anemia and electrolytes disturbances(sodium or potassium ion disturbance).Univariate analysis was used to analyze factors associated with favorable or unfavorable outcome in severe elderly aSAH patients,and multivariate Logistic regression analysis to determine factors affecting unfavorable outcome.Results(1)The length of stay(LOS)of 49 patients at ICU was 9-40 d(mean:17±7 d),with 2 died during in-hospital stay,and the other 47 discharged were all followed up with 1 died,resulting in a total mortality rate of 6.1%(3/49).Occurrence rate of cerebral vasospasm,cerebral infarction,pulmonary infection,hepatic dysfunction,hypoalbuminemia,anemia and electrolytes disturbance was 38.8%(19/49),24.5%(12/49),67.3%(33/49),22.4%(11/49),49.0%(24/49),53.1%(26/49)and 83.7%(41/49),respective

关 键 词：颅内动脉瘤 蛛网膜下腔出血 老年患者 HUNT-HESS分级 预后 

分 类 号：R743.35[医药卫生—神经病学与精神病学]