SAH后迟发性脑血管痉挛伴发脑梗死患者预后情况及危险因素分析  

Analysis of prognosis and risk factors in patients with delayed cerebral vasospasm and cerebral infarction after SAH

作　　者：张永亮 高鲁 杨金亮 王少华 ZHANG Yong-liang;GAO Lu;YANG Jin-liang;WANG Shao-hua(Department of Neurosurgery,Fuyang Hospital Affiliated to Anhui Medical University,Fuyang 236000;Department of Neurosurgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230000,Anhui,China)

机构地区：[1]安徽医科大学附属阜阳医院神经外科,安徽阜阳236000 [2]安徽医科大学第一附属医院神经外科,安徽合肥230000

出　　处：《川北医学院学报》2022年第8期1027-1031,共5页Journal of North Sichuan Medical College

基　　金：安徽医科大学校科研基金项目(2020xkjT032)。

摘　　要：目的:探究蛛网膜下腔出血(SAH)后迟发性脑血管痉挛(DCVS)伴发脑梗死的预后情况及危险因素。方法:选取72例动脉瘤导致SAH并发DCVS患者为研究对象,根据治疗后头颅CTA或MRA是否伴发迟发性脑梗死(DCI)分为梗死组(n=25)及非梗死组(n=47);采用单因素及多因素Logistic回归分析SAH后DCVS患者发生DCI的危险因素。结果:两组患者在高血压、Fisher(以II级上下为分组)分级、Hunt-Hess(以II级上下为分组)分级手术时间窗、白细胞计数、红细胞宽度(SD)、凝血酶原时间、纤维蛋白原、mRS评分方面比较,差异有统计学意义(P<0.05);其中梗死组mRS评分<4分患者占44.00%,4分≤mRS评分<6分占52.00%,死亡率占4.00%,与非梗死组比较(mRS评分<4分占78.72%,4分≤mRS评分<6分占17.02%,死亡率占4.26%),差异有统计学意义(P<0.05)。Hunt-Hess分级、改良Fisher分级、mRS评分、手术时间窗、纤维蛋白原及DCVS痉挛程度均是SAH后DCVS患者发生DCI的独立危险因素(P<0.05);凝血酶原时间及大脑中动脉血流量是保护因素(P<0.05)。结论:SAH并发DCVS应早诊断、早治疗并缩短手术治疗窗时间,术后关注患者血压、血凝等指标可降低预后DCI的发生,降低致残或致死的发生率。Objective:To explore the prognosis and risk factors in patients with delayed cerebral vasospasm(DCVS)and cerebral infarction after subarachnoid hemorrhage(SAH).Methods:72 patients with SAH complicated with DCVS caused by aneurysms were selected as the subjects,and divided into infarct group(n=25)and non-infarct group(n=47)according to whether CTA or MRA of the head was accompanied with delayed cerebral infarction(DCI)after treatment.Univariate and multivariate logistic regression were used to analyze the risk factors of DCI in DCVS patients after SAH.Results:There was significant difference in hypertension,Fisher(grouped by level II),Hunt-Hess(grouped by level II),operation time window,white blood cell count,red blood cell width(SD),prothrombin time,fibrin and mRS scores between the two groups(P<0.05).The scores of mRS less than 4 points of the infarct group accounted for 44.00%,≥4 and less than 6 points accounted for 52.00%,the mortality rate accounted for 4.00%,the scores of mRS less than 4 points of the non-infarct group accounted for 78.72%,≥4 and<6 points accounted for 17.02%,the mortality rate accounted for 4.26%,the differences were statistically significant(P<0.05).Hunt-Hess classification,modified Fisher classification,mRS score,Operation time window,fibrinogen and degree of DCVS spasticity were the independent risk factors of DCI in DCVS patients after SAH,prothrombin time and middle cerebral artery blood flow were the protective factors.Conclusion:SAH complicated with DCVs should be diagnosed and treated early,and the time of surgical treatment window should be shortened,pay attention to blood pressure,blood coagulation and other indicators after operation can reduce the occurrence of prognostic DCI,and reduce the incidence of disability or death.

关 键 词：蛛网膜下腔出血 迟发性脑血管痉挛 迟发性脑梗死 危险因素 预后 

分 类 号：R771[医药卫生—眼科]