脑脊液乳酸在动脉瘤性蛛网膜下腔出血术后转归中的预测价值研究  

Value of cerebrospinal fluid lactic acid in prognoses of aneurysmal subarachnoid hemorrhage

作　　者：严智 刘海波[1] 赵天全 王恩任[1] Yan Zhi;Liu Haibo;Zhao Tianquan;Wang Enren(Department of Neurosurgery,First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China)

机构地区：[1]成都医学院第一附属医院神经外科,成都610500

出　　处：《中华神经医学杂志》2020年第5期483-487,共5页Chinese Journal of Neuromedicine

摘　　要：目的明确动脉瘤性蛛网膜下腔出血(aSAH)患者脑脊液乳酸含量及乳酸清除率在患者预后中的预测价值。方法选择自2018年8月至2019年10月成都医学院第一附属医院神经外科收治的70例aSAH患者进入研究。所有患者于术后0~24 h、48~72 h、96~120 h 3个时间点内收集脑脊液检测乳酸含量并计算术后早期(0~72 h)乳酸清除率。术后3个月时对研究对象进行复诊与随访,根据改良Rankin量表(mRS)评分将患者分为预后良好组与预后不良组。采用单因素分析比较2组患者的临床资料及生化检查指标的差异,采用多因素Logistic回归分析筛选影响患者预后的独立因素。结果预后良好组患者共51例,预后不良组患者共19例。预后良好组患者年龄明显小于预后不良组,格拉斯哥昏迷量表(GCS)评分明显高于预后不良组,Hunt-Hess分级及改良Fisher分级分布明显优于预后不良组,差异均有统计学意义(P<0.05)。此外,预后良好组患者术后0~24 h、48~72 h脑脊液乳酸含量明显低于预后不良组,脑脊液乳酸平均值≤3.28 mol/L患者比例明显高于预后不良组,脑脊液乳酸清除率≥10%患者比例明显高于预后不良组,差异均具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示年龄(OR=1.089,95%CI:1.000~1.186,P=0.049)、GCS评分(OR=5.610,95%CI:1.136~27.696,P=0.034)、Hunt-Hess分级(OR=3.921,95%CI:1.084~14.175,P=0.037)、脑脊液乳酸清除率(OR=9.821,95%CI:1.278~75.483,P=0.028)是影响aSAH患者预后的独立因素。结论脑脊液乳酸清除率可预测aSAH患者术后转归情况,清除率≥10%患者预后较好。Objective To analyze the value of cerebrospinal fluid(CSF)lactic acid level and lactic acid clearance rate in arterial blood in predicting the prognoses of patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 70 patients with aSAH admitted to our hospital from August 2018 to October 2019 were selected.The clinical data and biochemical indexes of cerebrospinal fluid were collected,and the study subjects were re-examined and followed up 3 months after operation.The patients were divided into good prognosis group and poor prognosis group according to modified Rankin scale(mRS)scores.Univariate analysis was used to compare the clinical data and biochemical examination indicators of patients from the two groups.Multivariate Logistic regression analysis was used to screen the independent factors affecting the prognoses of the patients.Results There were 51 patients in the good prognosis group and 19 patients in the poor prognosis group.The patients in the good prognosis group had significantly younger age,significantly higher Glasgow coma scale(GCS)scores,and significantly better Hunt-Hess grading and modified Fisher classification distribution than those in the poor prognosis group(P<0.05).The contents of CSF lactic acid at 0-24 h and 48-72 h after surgery in the good prognosis group were significantly lower than those in the poor prognosis group(P<0.05);the percentages of patients with CSF lactic acid≤3.28 mol/L and patients with CSF lactic acid clearance≥10%were significantly higher than those of poor prognosis group(P<0.05).Multivariate Logistic regression analysis showed that age(OR=1.089,95%CI:1.000-1.186,P=0.049),GCS scores(OR=5.610,95%CI:1.136-27.696,P=0.034),Hunt-Hess grading(OR=3.921,95%CI:1.084-14.175,P=0.037),and CSF lactic acid clearance rate(OR=9.821,95%CI:1.278-75.483,P=0.028)were independent factors affecting the prognoses of aSAH patients.Conclusion CSF lactic acid clearance rate can predict the postoperative outcome of aSAH patients;patients with CSF lactic acid clearance rate

关 键 词：蛛网膜下腔出血 颅内动脉瘤 脑脊液乳酸 乳酸清除率 

分 类 号：R651[医药卫生—外科学]