腰池持续引流改善动脉瘤性蛛网膜下腔出血后急性脑积水患者的预后  

Continuous lumbar drainage improves prognosis in patients with acute hydrocephalus after aneurysmal subarachnoid hemorrhage

作　　者：文唐敏 苏俊 谭嘉禾 辛元君 车旭东[1] 梁译丹 邓杰文 杨小林 何朝晖[1] WEN Tangmin;SU Jun;TAN Jiahe;XIN Yuanjun;CHE Xudong;LIANG Yidan;DENG Jiewen;YANG Xiaolin;HE Zhaohui(Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016;Department of Neurosurgery,Changshou People’s Hospital,Chongqing,401220;Department of Neurosurgery,Nanchuan People’s Hospital,Chongqing,408499;Department of Neurosurgery,Chongqing Emergency Medical Center,Chongqing,400014,China)

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016 [2]重庆市长寿区人民医院神经外科,重庆401220 [3]重庆市南川区人民医院神经外科,重庆408499 [4]重庆市急救中心神经外科,重庆400014

出　　处：《陆军军医大学学报》2024年第4期384-390,共7页Journal of Army Medical University

基　　金：重庆市自然科学基金面上项目(CSTB2023NSCQ-MSX0112)。

摘　　要：目的 分析腰池引流量对动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage, aSAH)后急性脑积水(acute hydrocephalus, AHC)预后的影响。方法 纳入2017年1月至2022年1月就诊于重庆医科大学附属第一医院神经外科因动脉瘤性蛛网膜下腔出血发生AHC的患者82例。以出院半年后改良Rankin评分量表(modified Rankin scale, mRS)评分为预后结局,对人口学因素、入院时蛛网膜下腔出血(subarachnoid hemorrhage, SAH)严重程度、既往史、血管痉挛、腰池引流等数据进行单因素和多因素Logistic逐步回归分析,并构建列线图预测模型。结果 单因素分析发现WFNS、Hunt-Hess、mFisher、腰池引流时间、分流依赖、脑血管痉挛、腰池引流量可影响患者预后,进一步采用Logistic逐步回归分析,发现高评分WFNS(OR:3.25,95%CI:1.11~9.48)、mFisher高分级(OR:3.66, 95%CI:1.08~12.35)、发生分流依赖(OR:15.56,95%CI:1.22~198.57)与脑血管痉挛(OR:22.24,95%CI:3.08~160.68)是影响mRS的独立危险因素,腰池引流量(OR:0.57, 95%CI:0.40~0.82)是独立保护因素。ROC曲线面积显示模型具有良好的预测效果[AUC:0.898(95%CI:0.935~0.861)];通过Bootstrap方法进行内部验证,结果显示模型具很好的区分能力[C-index:0.950(95%CI:0.904~0.996);校正C-index:0.934]。结论 增加腰池引流量是aSAH术后发生AHC预后不良的独立保护因素,并可以改善SAH患者的预后。Objective To analyze the influence of drainage volume on prognosis of acute hydrocephalus(AHC)after aneurysmal subarachnoid hemorrhage(aSAH)by continuous lumbar drainage.Methods A retrospective trial was conducted on 82 AHC patients after aSAH admitted to the First Affiliated Hospital of Chongqing Medical University between January 2017 and January 2022.In 6 months after discharge,modified Rankin Scale(mRS)score was used to evaluate the prognostic outcomes.Univariate and multivariate logistic regression analyses were performed on demographic factors,severity of subarachnoid hemorrhage(SAH)at admission,medical history,cerebral vasospasm,and lumbar drainage data.Then a nomogram prediction model was constructed.Results Univariate analysis found that World Federation of Neurosurgical Societies(WFNS)score,Hunt-Hess grade,modified Fisher grade,time for continuous lumbar drainage,shunt dependence,cerebral vasospasm,and drainage volume were factors affecting the prognosis of the patients.Then logistic regression analysis revealed that high WFNS score(OR:3.25,95%CI:1.11~9.48),high modified Fisher grade(OR:3.66,95%CI:1.08~12.35),shunt dependence(OR:15.56,95%CI:1.22~198.57),and cerebral vasospasm(OR:22.24,95%CI:3.08~160.68)were independent predictors for mRS score,while volume of continuous lumbar drainage(OR:0.57,95%CI:0.40~0.82)was an independent protective factor.ROC curve analysis indicated a good predictive performance of the model(AUC=0.898,95%CI:0.935~0.861).Internal validation through Bootstrap method demonstrated excellent discriminatory ability of the model(C-index=0.950,95%CI:0.904~0.996;adjusted C-index:0.934).Conclusion Increased volume of lumbar drainage is an independent protective factor for poor prognosis following aSAH and can improve the prognosis of SAH patients.

关 键 词：动脉瘤 蛛网膜下腔出血 脑积水 腰池引流 

分 类 号：R651.12[医药卫生—外科学] R742.7[医药卫生—临床医学] R743.35