自发性蛛网膜下腔出血患者术后血尿酸水平与短期预后的关系  

Relationship between postoperative blood uric acid level and short-term prognosis of patients with spontaneous subarachnoid hemorrhage

作　　者：赵送会 李彪 岳赛超 苗旺[2] ZHAO Songhui;LI Biao;YUE Saichao;MIAO Wang(Intensive Care Unit,Zhoukou Central Hospital,Zhoukou,Henan 466000,China;Department of Neurology,the First Af filiated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]周口市中心医院ICU,河南周口466000 [2]郑州大学第一附属医院神经内科,河南郑州450052

出　　处：《中华实用诊断与治疗杂志》2024年第8期815-821,共7页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190087)。

摘　　要：目的观察自发性蛛网膜下腔出血(SAH)患者术后血尿酸水平变化及与短期预后的关系。方法2021年2月—2023年4月周口市中心医院诊治自发性SAH患者100例,均于入院5 d内行手术治疗,术后第1、3、5、7、14天检测血尿酸水平,根据术后3个月格拉斯哥预后评分(GOS)分为预后不良组(GOS评分≤3分)28例和预后良好组(GOS评分>3分)72例,比较预后不良组与预后良好组合并症、Hunt-Hess分级、Fisher分级、术后14 d内并发症、术后血尿酸水平等临床资料;采用多因素logistic回归分析自发性SAH患者术后3个月预后不良的影响因素;绘制ROC曲线,评估术后血尿酸预测自发性SAH患者术后3个月预后不良的效能。结果预后不良组合并脑室出血(32.14%)、合并颅内出血(25.00%)、Hunt-Hess分级Ⅳ~Ⅴ级(42.86%)、Fisher分级Ⅲ~Ⅳ级(64.29%)及术后迟发性脑缺血(25.00%)、院内再出血(35.71%)比率均高于预后良好组(4.17%、4.17%、8.33%、13.89%、6.94%、12.50%)(χ^(2)=14.942、9.722、16.280、25.398、6.224、7.059,P均<0.05)。预后不良组术后第1、3、5、7、14天血尿酸水平[(485.89±120.43)、(569.43±145.83)、(479.83±115.69)、(402.94±106.41)、(342.85±92.83)μmol/L]均高于预后良好组[(425.84±109.14)、(372.09±98.26)、(328.69±94.31)、(281.37±86.22)、(240.59±81.32)μmol/L](t=2.400、7.815、6.742、6.919、5.424,P均<0.05)。合并脑室出血(OR=3.483,95%CI:1.231~9.852,P<0.001)、合并颅内出血(OR=3.497,95%CI:1.075~11.374,P<0.001)、Hunt-Hess分级(OR=4.997,95%CI:1.362~18.337,P<0.001)、Fisher分级(OR=4.433,95%CI:1.275~15.413,P<0.001)、术后迟发性脑缺血(OR=10.080,95%CI:3.251~31.255,P<0.001)、术后院内再出血(OR=8.654,95%CI:2.111~35.478,P<0.001)、术后第1天血尿酸(OR=1.506,95%CI:1.013~2.056,P<0.001)、术后第3天血尿酸(OR=1.489,95%CI:1.020~2.174,P<0.001)、术后第5天血尿酸(OR=1.501,95%CI:1.022~2.204,P<0.001)、术后第7天血尿酸(OR=1.509,95%CI:1.024~2.225,P<0.001)、术后第14天血Objective To observe the changes in blood uric acid level after operation in patients with spontaneous subarachnoid hemorrhage(SAH)and its relationship with the short-term prognosis.Methods Totally 100 patients with spontaneous SAH were diagnosed and treated in Zhoukou Central Hospital from February 2021 to April 2023.All patients underwent operation within 5 days after admission.The blood uric acid level was detected on postoperative day 1,3,5,7 and 14.According to the Glasgow Outcome Scale(GOS)score 3 months after operation,100 patients were divided into 28 patients with GOS score≤3(poor prognosis group)and 72 patients with GOS>3(good prognosis group).The clinical data including comorbidities,Hunt-Hess grade,Fisher grade,complications within 14 days after operation,and postoperative blood uric acid level were compared between two groups.Multivariate logistic regression analysis was done to evaluate the influencing factors of poor prognosis 3 months after operation in spontaneous SAH patients.The ROC curve was plotted to evaluate the efficiency of postoperative blood uric acid on predicting poor prognosis 3 months after operation in spontaneous SAH patients.Results The proportions of intraventricular hemorrhage,intracranial hemorrhage,Hunt-Hess gradeⅣ-Ⅴ,Fisher gradeⅢ-Ⅳ,postoperative delayed cerebral ischemia,and in-hospital rebleeding were higher in poor prognosis group(32.14%,25.00%,42.86%,64.29%,25.00%,35.71%)than those in good prognosis group(4.17%,4.17%,8.33%,13.89%,6.94%,12.50%)(χ^(2)=14.942,9.722,16.280,25.398,6.224,7.059;all P values<0.05).The blood uric acid levels were higher in poor prognosis group on postoperative day 1,3,5,7 and 14[(485.89±120.43),(569.43±145.83),(479.83±115.69),(402.94±106.41),(342.85±92.83)μmol/L]than those in good prognosis group[(425.84±109.14),(372.09±98.26),(328.69±94.31),(281.37±86.22),(240.59±81.32)μmol/L](t=2.400,7.815,6.742,6.919,5.424;all P values<0.05).Intraventricular hemorrhage(OR=3.483,95%CI:1.231-9.852,P<0.001),intracranial hemorrhage(OR=3.497,9

关 键 词：自发性蛛网膜下腔出血 血尿酸 格拉斯哥预后评分 HUNT-HESS分级 Fisher分级 

分 类 号：R651.12[医药卫生—外科学]