高级别动脉瘤性蛛网膜下腔出血预后影响因素分析  

Influencing factors for prognoses of high-grade aneurysmal subarachnoid hemorrhage

作　　者：张国锋[1] 冷巧云[2] 刘慧 张心勇 曹志 刘卫兵[1] 梁锐[1] 胡利福 江文曲 唐尤佳 Zhang Guofeng;Leng Qiaoyun;Liu Hui;Zhang Xinyong;Cao Zhi;Liu Weibing;Liang Rui;Hu Lifu;Jiang Wenqu;Tang Youjia(Department of Neurosurgery,First People's Hospital of Jiujiang City,Jiujiang 332000,China;Department of Emergency,First People's Hospital of Jiujiang City,Jiujiang 332000,China;Clinical Skills Center,Clinic Medical College,Jiujiang University,Jiujiang 332000,China)

机构地区：[1]九江市第一人民医院神经外科,332000 [2]九江市第一人民医院急诊科,332000 [3]九江学院临床医学院临床技能中心,九江332000

出　　处：《中华神经医学杂志》2021年第4期378-383,共6页Chinese Journal of Neuromedicine

基　　金：江西省卫生健康委科技计划项目(202140277)。

摘　　要：目的探讨高级别动脉瘤性蛛网膜下腔出血(aSAH)患者的预后影响因素。方法选择九江市第一人民医院神经外科自2012年1月至2020年3月收治的104例aSAH患者进入研究,根据出院3个月时改良Rankin量表(mRS)评分将患者分为预后良好组(mRS评分≤2分)及预后不良组(mRS评分>2分)。比较2组患者各项临床资料并采用多因素Logistic回归分析明确影响其预后的独立因素。结果104例患者中预后良好组患者40例(38.5%),预后不良组患者64例(61.5%)。与预后不良组患者比较,预后良好组患者年龄≥60岁比例、Graeb评分、第四脑室铸型发生率及Fisher分级均偏低,血钾含量偏高,血糖含量偏低,舒张压、收缩压、平均动脉压明显偏低,差异均有统计学意义(P<0.05)。治疗方式及并发症发生率方面,2组患者差异亦有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:年龄≥60岁(OR=13.470,95%CI:2.177~83.347,P=0.005)、Fisher分级(OR=6.649,95%CI:1.141~38.736,P=0.035)、保守治疗(OR=6.348,95%CI:1.048~38.742,P=0.044)、入院时平均动脉压(OR=29.721,95%CI:3.177~278.012,P=0.003)、血钾(OR=5.296,95%CI:1.138~24.653,P=0.034)、第四脑室铸型(OR=9.855,95%CI:1.785~51.456,P=0.008)、慢性脑积水(OR=19.298,95%CI:3.294~113.069,P=0.001)是影响高级别aSAH患者预后的独立因素。结论高龄、Fisher分级较高、平均动脉压偏高、血钾含量偏低、存在第四脑室铸型及慢性脑积水的重症保守治疗患者更易出现不良预后。Objective To investigate the influencing factors for prognoses of patients with high-grade aneurysmal subarachnoid hemorrhage(aSAH).Methods A retrospective analysis was performed on clinical data of 104 patients with aSAH,admitted to our hospital from January 2012 to March 2010.According to the modified Rankin scale(mRS)scores 3 months after discharge,these patients were divided into good prognosis group(mRS scores≤2)and poor prognosis group(mRS scores>2).Clinical data of patients from the 2 groups were compared.Multivariate Logistic regression analysis was used to analyze the influencing factors for prognoses.Results Forty patients(38.5%)were with good prognosis and 64(61.5%)were with poor prognosis.As compared with patients in the poor prognosis group,patients in the good prognosis group had significantly lower proportion of patients>60 years old,and significantly lower Graeb scores,cast fourth ventricle(CFV)incidence,Fisher grading,blood glucose content,diastolic blood pressure,systolic blood pressure and mean arterial pressure,and statistically higher serum potassium content(P<0.05).There were significant differences in treatment methods and incidence of complications between the two groups(P<0.05).Multivariate Logistic regression analysis showed that age>60 years(OR=13.470,95%CI:2.177-83.347,P=0.005),Fisher grading(OR=6.649,95%CI:1.141-38.736,P=0.035),conservative treatment(OR=6.348,95%CI:1.048-38.742,P=0.044),mean arterial pressure at admission(OR=29.721,95%CI:3.177-278.012,P=0.003),serum potassium(OR=5.296,95%CI:1.138-24.653,P=0.034),CFV(OR=9.855,95%CI:1.785-51.456,P=0.008),and chronic hydrocephalus(OR=19.298,95%CI:3.294-113.069,P=0.001)were influencing factors for prognoses of high-grade aSAH patients.Conclusion Severe aSAH patients with advanced age,high Fisher grading,high mean arterial pressure,low serum potassium content,fourth ventricle casting and chronic hydrocephalus under conservative treatment are more likely to have poor prognosis.

关 键 词：蛛网膜下腔出血 动脉瘤 预后 影响因素 

分 类 号：R743.35[医药卫生—神经病学与精神病学]