动脉瘤性蛛网膜下腔出血介入治疗后慢性意识障碍的危险因素  

Predictors of prolonged disorders of consciousness after intervention for aneurysmal subarachnoid hemorrhage

作　　者：韩超 王如海 张成 杨东升 于强 胡海成 HAN Chao;WANG Ruhai;ZHANG Cheng;YANG Dongsheng;YU Qiang;HU Haicheng(The Second Affiliated Hospital of Fuyang Normal University,Fuyang 236000,China)

机构地区：[1]阜阳师范大学附属第二医院,安徽阜阳236000

出　　处：《中国实用神经疾病杂志》2022年第7期813-818,共6页Chinese Journal of Practical Nervous Diseases

基　　金：安徽省科技重大专项项目(编号:201903a07020006)。

摘　　要：目的探讨动脉瘤性蛛网膜下腔出血(aSAH)患者经介入治疗后出现慢性意识障碍(pDoC)的术前影响因素。方法分析2019-05—2022-03阜阳师范大学附属第二医院治疗的102例动脉瘤破裂蛛网膜下腔出血患者的术前临床资料。根据aSAH患者介入治疗后28 d意识情况分为pDoC组和非pDoC组,通过单因素和多因素Logistic回归分析介入术后SAH患者pDoC形成的危险因素。采用受试者工作特征曲线(ROC)分析影响因素预测pDoC的能力。结果单因素分析提示,术前血清葡萄糖和钾的比值、白细胞计数、血糖、Hunt-Hess分级、急性脑积水、颅内血肿、脑出血破入脑室等是pDoC形成的可能影响因素(P<0.05)。多因素Logistic回归分析显示,Hunt-Hess分级、急性脑积水、颅内血肿等为pDoC的独立危险因素(P<0.05)。以Hunt-Hess分级等危险因素为检验变量,以pDoC为状态变量绘制aSAH受试者特征工作曲线,术前Hunt-Hess分级的AUC为0.895(95%CI:0.818~0.947,P<0.001),约登指数为0.4893,敏感度76.20%,特异度91.4%。急性脑积水、颅内血肿、Hunt-Hess分级联合预测预后的AUC为0.924(95%CI:0.855~0.967,P<0.001),敏感度85.71%,特异度91.36%。结论aSAH患者较高级别的Hunt-Hess分级、合并急性脑积水、颅内血肿等可能与术后pDoC有关,3种危险因素同时发生可能造成pDoC机会更高。Objective To investigate the preoperative risk factors of prolonged disorders of consciousness(pDoC)in patients with aneurysmal subarachnoid hemorrhage after interventional therapy.Methods The preoper⁃ative clinical data of 102 patients with ruptured subarachnoid hemorrhage aneurysm from May 2019 to March 2022 were reviewed.The patients with aneurysmal subarachnoid hemorrhage were divided into pDoC group and non-pDoC group according to their consciousness 28 days after interventional therapy.The risk factors of pDoC for⁃mation were revealed by univariate and multivariate Logistic regression analysis.Receiver characteristic curve(ROC)was used to analyze the ability to predict pDoC.Results According to the results of univariate analysis,the ratio of serum glucose and potassium,white blood cell count,blood glucose,Hunt-Hess grade,acute hydroceph⁃alus,intracerebral hematoma,and rupture of intracerebral hemorrhage into ventricles were the possible influencing factors of pDoC(P<0.05).Multiple Logistic regression factors analysis showed that Hunt-Hess grade,acute hydro⁃cephalus and intracerebral hematoma were independent risk factors of pDoC(P<0.05).Risk factors such as Hunt-Hess grade were used as test variables,and prognostic pDoC was used as state variable to draw ROC.The AUC of Hunt-Hess grade classification was 0.895(95%CI:0.818-0.947,P<0.001),the Yorden index was 0.4893,the sensitivity was 76.20%,the specificity was 91.4%.The AUC of combined of acute hydrocephalus,intracranial hematoma and Hunt-Hess classification predicts prognosis was 0.924(95%CI:0.855-0.967,P<0.001),sensitivity was 85.71%,specificity was 91.36%.Conclusion The higher Hunt-Hess grade,acute hydrocephalus and intracra⁃nial hematoma in patients with aSAH may be related to pDoC,and more risk factors may result in higher chance of pDoC.

关 键 词：脑动脉瘤破裂 蛛网膜下腔出血 介入治疗 慢性意识障碍 影响因素 

分 类 号：R743.35[医药卫生—神经病学与精神病学]