颅内动脉瘤性蛛网膜下腔出血患者介入栓塞术后脑积水发生情况及高危因素分析  

Analysis of Hydrocephalus and High Risk Factors in Patients with Intracranial Aneurysmal Subarachnoid Hemorrhage after Interventional Embolization

作　　者：欧阳仲瑞 蔡昭文 黄建兴[1] 江志贤[1] OUYANG Zhongrui;CAI Zhaowen;HUANG Jianxing(Department of Neurosurgery,Quanzhou First Hospital,Fujian Province 362100)

机构地区：[1]福建省泉州市第一医院神经外科,362100

出　　处：《医学理论与实践》2023年第9期1441-1443,1455,共4页The Journal of Medical Theory and Practice

摘　　要：目的:研究颅内动脉瘤性蛛网膜下腔出血(SAH)患者介入栓塞术后脑积水发生情况及高危因素。方法:回顾性分析2019年3月—2022年3月我院收治的187例颅内动脉瘤性SAH患者的临床资料,根据介入栓塞术后脑积水发生情况,将发生脑积水的42例纳入A组,未发生脑积水的145例患者纳入B组。比较两组患者的临床资料,分析动脉瘤性SAH患者行介入栓塞术后发生脑积水的高危因素。结果:两组患者性别、高血压病史、吸烟史、饮酒史、动脉瘤大小、动脉瘤位置、术后有无颅内感染差异无统计学意义(P>0.05);年龄、入院时动脉瘤性SAH的临床状态(Hunt-Hess分级)、出血次数、出血是否破入脑室、入院时SAH出血状态(Fisher分级)、早期腰池引流情况与脑积水显著相关(P<0.05);多因素回归分析结果显示:高等级Hunt-Hess分级、出血破入脑室、高等级Fisher分级是动脉瘤性SAH患者介入栓塞术后脑积水的独立危险因素(P<0.05),早期腰池引流为介入栓塞术后脑积水的独立保护因素(P<0.05)。结论:高等级Hunt-Hess分级(≥Ⅲ级)、出血破入脑室、高等级Fisher分级(≥Ⅲ级)是动脉瘤性SAH患者介入栓塞术后脑积水的独立危险因素,临床需结合对应危险源进行防治,而及时进行早期腰池引流对预防脑积水有利。Objective:To study the incidence and high risk factors of hydrocephalus in patients with intracranial aneurysmal subarachnoid hemorrhage(SAH)after interventional embolization.Methods:The clinical data of 187 patients with intracranial aneurysmal SAH admitted to our hospital from March 2019 to March 2022 were analyzed retrospectively.According to the occurrence of hydrocephalus after interventional embolization,42 patients with hydrocephalus were included in group A,and 145 patients without hydrocephalus were included in group B.The clinical data of the two groups were compared,and the high risk factors of hydrocephalus in patients with aneurysmal SAH after interventional embolization were analyzed.Results:There was no significant difference between the two groups in gender,hypertension history,smoking history,drinking history,aneurysm size,aneurysm location,and intracranial infection after surgery(P>0.05).Age,clinical status of aneurysmal SAH at admission(Hunt Hess grade),number of bleeding,whether bleeding broke into ventricle,SAH bleeding status at admission(Fisher grade),and early lumbar cistern drainage were significantly correlated with hydrocephalus(P<0.05).Multivariate regression analysis showed that high grade Hunt Hess grade,bleeding into ventricle and high grade Fisher grade were independent risk factors for hydrocephalus after interventional embolization in patients with aneurysmal SAH(P<0.05),and early lumbar drainage was independent protective factor for hydrocephalus after interventional embolization(P<0.05).Conclusion:High grade Hunt Hess grade(≥GradeⅢ),hemorrhage breaking into ventricles,and high grade Fisher grade(≥GradeⅢ)are independent risk factors for hydrocephalus after interventional embolization in patients with aneurysmal SAH.It is necessary to combine the corresponding risk sources for prevention and treatment in clinical practice,and timely lumbar drainage is beneficial to prevent hydrocephalus.

关 键 词：颅内动脉瘤性蛛网膜下腔出血 介入栓塞术 脑积水 高危因素 

分 类 号：R743.35[医药卫生—神经病学与精神病学]