成人高分级动脉瘤性蛛网膜下腔出血术后脑室外引流量与脑积水的相关性研究  

Study on the correlation between ventricular drainage volume and hydrocephalus after operation of poor-grade aneurysmal subarachnoid hemorrhage in adults

作　　者：徐小梅 王玉海 陈涛 XU Xiaomei;WANG Yuhai;CHEN Tao(Department of Neurosurgery,904 Hospital of PLA Logistics Joint Support Force,Wuxi 214000,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇四医院神经外科,无锡214000

出　　处：《临床神经外科杂志》2024年第6期678-682,共5页Journal of Clinical Neurosurgery

基　　金：无锡市科技发展资金项目(N20201008)。

摘　　要：目的 探讨脑室外引流量对成人高分级动脉瘤性蛛网膜下腔出血(PaSAH)术后发生分流依赖性脑积水(SDHC)的影响,并确定最佳引流量截断值,为减少SDHC的发生提供临床依据。方法 回顾性分析联勤保障部队第九〇四医院神经外科2011年10月-2020年12月间收治的80例PaSAH患者的临床资料,术后随访时间≥1年。结果 本研究共纳入80例PaSAH患者,其中发生SDHC 39例(48.8%),未发生SDHC 41例(51.2%)。与非SDHC组相比,SDHC组术后第1、2、3天内与置管全程脑室外日均引流量显著高于非SDHC组,差异有统计学意义(P<0.05)。修正Possion回归分析显示,术后前3 d引流量增加均提高了SDHC的风险,差异有统计学意义。受试者工作特征(ROC)曲线分析结果显示,术后第1天脑室外引流量对PaSAH术后SDHC具有良好的预测能力,曲线下面积(AUC)为0.829,最佳截断值为208 mL,灵敏度为79.4%,特异度为81.6%,约登指数为0.61。结论 脑室外引流置入后前3 d随着引流量的增加术后发生SDHC的风险逐渐升高。术后第1天脑室外引流量>208 mL为PaSAH后发生SDHC风险增加的最佳截断值。Objective To investigate the effect of external ventricular drainage volume on shunt-dependent hydrocephalus(SDHC)after operation of adult poor-grade aneurysmal subarachnoid hemorrhage(PaSAH),and to determine the optimal cut-off value of drainage flow,so as to provide clinical basis for reducing the occurrence of SDHC.Methods The clinical data of 80 patients with PaSAH admitted to Department of Neurosurgery,904 Hospital of PLA Logistics Joint Support Force from October 2011 to December 2020 were analyzed retrospectively,and the follow-up time was≥1 year.Results A total of 80 patients with PaSAH were included in this study,of which 39 cases(48.8%)developed SDHC and 41 cases(51.2%)not.Compared with non-SDHC group,the average daily drainage volume in the first day,the first two days,the first 3 days after operation and the whole catheterization in the SDHC group was significantly higher than that in the non-SDHC group.The difference was statistically significant(P<0.05).Modified Possion regression analysis showed that increased drainage volume in the first there days after operation increased the risk of SDHC.The difference was statistically significant.Receiver operating characteristic(ROC)curve analysis showed that ventricular drainage volume on the first day after surgery had a good predictive ability for SDHC after PaSAH surgery,and its area under curve(AUC)was 0.829,the best cut-off value was 208 mL,with a sensitivity of 79.4%,a specificity of 81.6%and a Joden index of 0.61.Conclusions The risk of postoperative SDHC gradually increases with the increase of drainage volume in the first 3 days after the placement of intraventricular drainage.The drainage volume of external ventricular drainage>208 mL in the first day after operation is the best cut-off value for the increased risk of SDHC after PaSAH.

关 键 词：蛛网膜下腔出血 高分级动脉瘤 脑室外引流 分流依赖性脑积水 

分 类 号：R743[医药卫生—神经病学与精神病学]