非增强CT扫描定位动脉瘤性蛛网膜下腔出血患者破裂动脉瘤的准确性及其对预后的预测价值研究  

Accuracy of Non-enhanced Computed Tomography in Locating Ruptured Aneurysms in Patients with Aneurysmal Subarachnoid Hemorrhage and Its Predictive Value for Prognosis

作　　者：高洁[1] 玉王宁 刘鑫 刘岩[3] 苗玲 王敏[4] 王莹 张辉[1] GAO Jie;YU Wangning;LIU Xin;LIU Yan;MIAO Ling;WANG Min;WANG Ying;ZHANG Hui(Department of Radiology,Affiliated Hospital of Hebei Engineering University,Handan 056002,China;Medical College,Hebei University of Engineering,Handan 056038,China;Department of Radiology,Handan Second Hospital,Handan 056001,China;Surgical Department,Handan Central Hospital,Handan 056001,China)

机构地区：[1]河北工程大学附属医院医学影像科,河北省邯郸市056002 [2]河北工程大学医学院医学系,河北省邯郸市056038 [3]河北省邯郸市第二医院影像科,056001 [4]河北省邯郸市中心医院外科,056001

出　　处：《实用心脑肺血管病杂志》2021年第5期97-103,共7页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：背景目前,非增强CT扫描(NECT)定位动脉瘤性蛛网膜下腔出血(aSAH)患者破裂动脉瘤的准确性及其对预后的预测价值尚存在争议。目的探讨NECT定位多发性aSAH患者破裂动脉瘤的准确性及其对aSAH患者预后的预测价值。方法选取2015—2019年邯郸市第二医院诊治的243例aSAH患者。记录NECT定位多发性aSAH患者破裂动脉瘤的准确性,比较正确定位和错误定位的多发性aSAH患者年龄、性别、并发症发生情况、Hijdra评分、破裂动脉瘤大小及破裂动脉瘤位置。术后3个月门诊随访时采用格拉斯哥预后量表(GOS)评估患者预后,比较预后良好与预后不良的aSAH患者年龄、性别、并发症发生情况、吸烟史、饮酒史、Fisher评分、破裂动脉瘤位置、脑积水发生情况、脑室内出血发生情况、动脉瘤类型及初始、随访视神经鞘管直径(ONSD)指数。NECT定位多发性aSAH患者破裂动脉瘤准确性的影响因素及aSAH患者预后的影响因素分析采用多因素Logistic回归分析;绘制受试者工作特征(ROC)曲线以评估Fisher评分、初始ONSD指数及二者联合对aSAH患者预后的预测价值。结果NECT正确定位多发性aSAH患者破裂动脉瘤的符合率为79.7%(55/69),其中正确定位破裂大脑前循环动脉瘤的符合率为90.9%(30/33),其他部位为69.4%(25/36)。243例aSAH患者术后3个月预后良好196例,预后不良47例。多因素Logistic回归分析结果显示,并发症及破裂动脉瘤大小是NECT定位多发性aSAH患者破裂动脉瘤准确性的独立影响因素(P<0.05);年龄、糖尿病、Fisher评分、初始ONSD指数和随访ONSD指数是aSAH患者预后不良的独立影响因素(P<0.05)。ROC曲线分析结果显示,Fisher评分、初始ONSD指数及二者联合预测aSAH患者预后的AUC分别为0.612〔95%CI(0.495,0.724)〕、0.623〔95%CI(0.512,0.736)〕、0.747〔95%CI(0.649,0.858)〕。结论NECT正确定位多发性aSAH患者破裂动脉瘤的符合率为79.7%,尤其是破裂�Background At present,the accuracy of non-enhanced computed tomography(NECT)to locate the rupture aneurysms in patients with aneurysmal subarachnoid hemorrhage(aSAH)and its predictive value for prognosis are still controversial.Objective To explore the accuracy of NECT in locating ruptured aneurysms in patients with multiple aSAH and its predictive value for prognosis of patients with aSAH.Methods A total of 243 aSAH patients were selected from Handan Second Hospital from 2015 to 2019.The accuracy of NECT in locating ruptured aneurysms in patients with multiple aSAH was recorded,and the age,gender,incidence of complications,Hijdra score,size of ruptured aneurysms and location of ruptured aneurysms between correctly located and wrongly located patients with multiple aSAH.The Glasgow Outcome Scale(GOS)was used to assess the prognosis of patients with aSAH 3-month after surgery.The age,gender,incidence of complications,smoking history,drinking history,Fisher score,location of ruptured aneurysm,incidence of hydrocephalus,incidence of intraventricular hemorrhage,aneurysm type and optic nerve sheath diameter(ONSD)index at initial and follow-up in aSAH patients with good prognosis and poor prognosis were compared.The influencing factors of accuracy of NECT in locating ruptured aneurysms in patients with multiple aSAH and prognosis in patients with aSAH were analyzed by multivariate Logistic regression analysis.The receiver operating characteristic(ROC)curves were drawn to evaluate the predictive value of Fisher score,initial ONSD index and their combination in predicting prognosis of patients with aSAH.Results The coincidence rate of NECT in accurately locating ruptured aneurysm in patients with multiple aSAH was 79.7%(55/69),among which the coincidence rate of NECT in accurately locating ruptured anterior circulation aneurysm was 90.9%(30/33),and other parts was 69.4%(25/36).Three months after surgery,196 cases of the 243 patients with aSAH had a good prognosis,while 47 cases had a poor prognosis.Multivariate Logistic

关 键 词：动脉瘤蛛网膜下腔出血 非增强CT扫描 预后 预测价值 

分 类 号：R743.35[医药卫生—神经病学与精神病学]