动脉瘤性蛛网膜下腔出血后脑血管痉挛预测因素的临床研究  

Clinical research on the predictors of cerebral vasospasm after aneurysmal subarachnoid hemorrhage

作　　者：乾栋梁 李伟 柴尔青[1] QIAN Dongliang;LI Wei;CHAI Erqing(Gansu Provincial People’s Hospital,Lanzhou 730000,China)

机构地区：[1]甘肃省人民医院,甘肃兰州730000

出　　处：《中国实用神经疾病杂志》2021年第11期948-953,共6页Chinese Journal of Practical Nervous Diseases

基　　金：甘肃省人民医院院内科研基金项目(编号:20GSSY4-53)。

摘　　要：目的通过分析动脉瘤性蛛网膜下腔出血(aneurysmalsubarachnoidhemorrhage,aSAH)发生和不发生脑血管痉挛患者的相关因素,寻找可能有效的指标,以期早期筛查出发生脑血管痉挛的高危险患者。方法收集2017-01-2020-10甘肃省人民医院脑血管病中心收治的动脉瘤性蛛网膜下腔出血151例。根据有无发生脑血管痉挛分为2组,其中脑血管痉挛组51例,无脑血管痉挛组100例,比较2组年龄、性别、Hunt-Hess分级、改良Fisher评分,血C反应蛋白(bloodC-reactiveprotein,CRP)、血白细胞、血糖、血钾及血糖/血钾等,绘制ROC曲线,寻找血糖/血钾的最佳截断值,利用多因素Logistic回归分析筛查相关危险因素。结果脑血管痉挛组与无脑血管痉挛组年龄(分别为48.65±6.78,57.23±9.05)、Fisher评分(分别为2.17±1.01,1.58±0.62)差异有统计学意义(P<0.05),血糖/血钾值(分别为1.74±0.32,1.12±0.22)差异有统计学意义(P<0.01),血糖/血钾的比值为1.3737时,约登指数最大。多因素Logistic回归分析显示,改良Fisher评分(OR值0.315,95%可信区间0.145~0.684,P=0.004)、血糖/血糖(OR值46.753,95%可信区间15.840~138.002,P=0)是aSAH患者发生血管痉挛的独立危险因素(P<0.05)。结论改良Fisher评分较高、血糖/血糖比值较高为aSAH患者发生脑血管痉挛的独立危险因素,血糖/血钾>1.373时可能有效预测脑血管痉挛的发生。Objective To find possible effective indicators by analyzing the related factors of aneurysmal subarachnoid hemorrhage(aSAH)and non-cerebrovascular spasm patients in order to screen out the high risk patients with cerebral vasospasm.Methods A total of 151 cases of aneurysmal subarachnoid hemorrhage from January 2017 to October 2020.According to the occurrence of cerebral vasospasm,51 cases were divided into in the cerebral vasospasm group,100 cases in the anencephalic vasospasm group.The age,sex,Hunt-Hess grade,modified Fisher grades,blood C-reactive protein(CRP),white blood cells(WBC),serum glucose,serum potassium,serum glucose/serum potassium of the two groups were compared.Draw ROC curves and find the best cut-off for serum glucose/serum potassium.Multivariate Logistic regression analysis was used to screen related risk factors.Results There were significant differences in age(48.65±6.78,57.23±9.05),modified Fisher grades(2.17±1.01,1.58±0.62)and serum glucose/serum potassium(1.74±0.32,1.12±0.22)between the two groups(P<0.05).When the ratio of serum glucose/serum potassium is 1.3737.The Youden index is the largest.The results of multivariate Logistic regression analysis showed that the modified Fisher grades(OR=0.315,95%CI 0.145-0.684,P=0.004),serum glucose/serum potassium(OR=46.753,95%CI 15.840-138.002,P=0)were independent risk factors for vasospasm in aSAH patients(P<0.05).Conclusion The high score of modified Fisher and the high ratio of serum glucose/serum potassium are the independent risk factors for cerebral vasospasm in aSAH patients.

关 键 词：动脉瘤性蛛网膜下腔出血 脑血管痉挛 C反应蛋白 白细胞 血糖/血钾 

分 类 号：R743.35[医药卫生—神经病学与精神病学]