动脉瘤性蛛网膜下腔出血并发心肌损伤的临床特征及预后分析  

Clinical features and prognostic analysis of aneurysmal subarachnoid hemorrhage complicated with myocardial injury

作　　者：陈艳[1,2] 郑峥[1,3] 程琼[1,3] 李永坤[1,3] 汪银洲[1,3] Chen Yan;Zheng Zheng;Cheng Qiong;Li Yongkun;Wang Yinzhou(Shengli Clinical Medical College of Fujian Medical University,Fuzhou 350001,China;Department of General Practice,Fujian Provincial Hospital,Fuzhou 350001,China;Department of Neurology,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福州350001 [2]福建省立医院全科医学科,福州350001 [3]福建省立医院神经内科,福州350001

出　　处：《创伤与急诊电子杂志》2020年第3期118-122,共5页Journal of Trauma and Emergency(Electronic Version)

基　　金：福建省自然科学基金卫生联合面上项目(2017J01240,2017J01176);福建省卫生健康中青年骨干人才培养项目(2019-ZQN-3)。

摘　　要：目的探讨动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)后发生心肌损伤患者的临床特征及预后。方法回顾384例符合纳入标准的aSAH患者的临床资料,根据心肌肌钙蛋白I(cardiac troponin I,cTnI)是否增高,分为cTnI增高组(n=59)和cTnI正常组(n=325)。记录患者的基线资料、蛛网膜下腔出血(subarachnoid hemorrhage,SAH)临床分级、N末端B型利尿钠肽原(N-terminal pro B-type natriuretic peptide,NT-proBNP)水平、心电图、并发症等信息。所有患者均实施血管内治疗并随访90d,采用改良Rankin量表(modified Rankin Scale,mRS)评估预后。结果与cTnI正常组比较,cTnI增高组格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)评分更低,Hunt-Hess分级、Fisher分级更高,差异均有统计学意义(P<0.05)。cTnI增高组心电图异常发生率、并发癫痫、脑积水、脑梗死、神经源性肺水肿(neurogenic pulmonary edema,NPE)的发生率分别为81.36%、11.86%、22.03%、37.29%、20.34%,高于cTnI正常组[57.54%、2.46%、5.85%、21.54%、0%(P<0.05)]。cTnI增高组患者预后不良率(57.63%)高于cTnI正常组(11.38%),差异有统计学意义(P<0.05)。12例并发NPE的患者中83.33%预后不良,75%死亡。结论aSAH后并发心肌损伤的患者神经功能损伤较严重,临床预后较差,应尽早识别此类患者,给予积极合理的救治。Objective To explore the clinical characteristics and prognosis of patients with myocardial injury after aneurysmal subarachnoid hemorrhage(aSAH).Methods The clinical data of 384 aSAH patients who met the inclusion criteria were reviewed.According to whether cardiac troponin I(cTnI)is increased,they were divided into increased cTnI group(n=59)and and normal cTnI group(n=325).Their baseline data,subarachnoid hemorrhage(SAH)clinical grade,N-terminal pro B-type natriuretic peptide(NT-proBNP)level,electrocardiogram,complications and other information were recorded.All patients were treated with endovascular treatment and followed up for 90 days.The prognosis was assessed by Modified Rankin Scale(mRS).Results Compared with the normal cTnI group,the increased cTnI group had a lower Glasgow Coma Scale(GCS)score,and higher Hunt-Hess classification and Fisher classification.The differences were statistically significant(P<0.05).The incidence of abnormal ECG,epilepsy,hydrocephalus,cerebral infarction,and neurogenic pulmonary edema(NPE)in the increased cTnI group were 81.36%,11.86%,22.03%,37.29%,20.34%,respectively,which were higher than those in the normal cTnI group[57.54%,2.46%,5.85%,21.54%,0%(P<0.05)].The poor prognosis rate of patients in the increased cTnI group(57.63%)was higher than that in the cTnI normal group(11.38%),and the difference was statistically significant(P<0.05).Among the 12 patients with NPE,83.33% had a poor outcome and 75% died.Conclusion Patients with myocardial injury after aSAH have severe neurological damage and poor clinical prognosis.Such patients should be identified as early as possible and given active and reasonable treatment.

关 键 词：动脉瘤 蛛网膜下腔出血 心肌损伤 肌钙蛋白 预后 

分 类 号：R743.35[医药卫生—神经病学与精神病学] R542.2[医药卫生—临床医学]