aSAH患者术后发生延迟性脑缺血的影响因素及风险预警模型构建  

Multivariate regression analysis and predictive value of postoperative delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage

作　　者：马建宁 徐占义 张洪鑫 MA Jianning;XU Zhanyi;ZHANG Hongxin(Hengshui People’s Hospital Affiliated to Hebei Medical University,Hengshui 053000,China)

机构地区：[1]河北医科大学附属衡水市人民医院,河北衡水053000

出　　处：《中国实用神经疾病杂志》2024年第4期453-457,共5页Chinese Journal of Practical Nervous Diseases

基　　金：河北省医学科学研究课题(编号:20221503)。

摘　　要：目的探究动脉瘤性蛛网膜下腔出血(aSAH)患者术后发生延迟性脑缺血的影响因素,构建风险预警模型并分析其预测价值。方法选取2020-01—2023-06河北医科大学附属衡水市人民医院收治的97例aSAH患者为研究对象,均行手术治疗。根据术后是否发生延迟性脑缺血分为发生组(29例)和未发生组(68例)。采用Logistic多因素回归分析aSAH患者术后发生延迟性脑缺血的影响因素,采用受试者工作特征(ROC)曲线评估危险因素对aSAH患者术后发生延迟性脑缺血的预测价值,并构建a SAH患者术后发生延迟性脑缺血的指数方程。结果单因素分析显示,发生组患者年龄、动脉瘤直径、Hunt-Hess分级、改良Fisher分级、脑积水、脑血管痉挛、中性粒细胞与淋巴细胞计数比值(NLR)等与未发生组比较差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,Hunt-Hess分级、改良Fisher分级、脑血管痉挛、NLR是影响aSAH患者术后发生延迟性脑缺血的危险因素(P<0.05)。aSAH患者术后发生延迟性脑缺血的指数方程为PI=0.902X_(3)+0.875X_(4)+1.263X_(6)+1.006X_(7),ROC曲线分析显示,ROC曲线下面积、灵敏度、特异度分别为0.792、86.41%、76.29%。经Hosmer-Lemeshow检验,模型的校准度和一致性较好(χ^(2)=8.492,P=0.537)。结论aSAH患者术后发生延迟性脑缺血与Hunt-Hess分级、改良Fisher分级、脑血管痉挛、NLR有关,基于以上因素构建的预测模型具有一定预测价值。Objective To investigate the influencing factors for postoperative delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage(aSAH),and establish a risk warning model and analyze its predictive value.Methods Totally 97 patients with aSAH admitted to Hengshui People’s Hospital Affiliated to Hebei Medical University from January 2020 to June 2023 were selected as the study objects,all of whom underwent surgical treatment.According to whether delayed cerebral ischemia occurred after operation,the patients were divided into the occurrence group(29 cases)and the non-occurrence group(68 cases).Multivariate Logistic regression was used to analyze the influencing factors,receiver operating characteristic(ROC)curve was used to evaluate the predictive value,and exponential equations were constructed.Results Age,aneurysm diameter,Hunt-Hess grade,modified Fisher grade,hydrocephalus,cerebrovascular spasm,and neutrophil to lymphocyte count ratio(NLR)of patients in the occurrence group were significant compared with those in the non-occurrence group(P<0.05).Multivariate Logistic regression analysis showed that Hunt-Hess grading,modified Fisher grading,cerebral vasospasm and NLR were risk factors for postoperative delayed cerebral ischemia in aSAH patients(P<0.05).The exponential equation of postoperative delayed cerebral ischemia in aSAH patients was PI=0.902X_(3)+0.875X_(4)+1.263X_(6)+1.006X_(7).ROC curve analysis results showed that the area,sensitivity and specificity under ROC curve were 0.792,86.41%and 76.29%,respectively.Hosmer-Lemeshow test shows that the calibration degree and consistency of the model are good(χ^(2)=8.492,P=0.537).Conclusion Delayed cerebral ischemia in aSAH patients after surgery is related to Hunt-Hess grading,modified Fisher grading,cerebral vasospasm,and NLR.The prediction model based on the above factors has certain predictive value.

关 键 词：动脉瘤性蛛网膜下腔出血 动脉瘤破裂 延迟性脑缺血 影响因素 预测价值 

分 类 号：R743.35[医药卫生—神经病学与精神病学]