蛛网膜下腔出血后迟发性缺血性神经功能缺损的危险因素分析  

Analysis of risk factors of delayed ischemic neurological deficit after subarachnoid hemorrhage

作　　者：周汉诚 邵文华 ZHOU Hancheng;SHAOWenhua(Department of Neurosurgery,Wuxue First People's Hospital,Huanggang,Hubei,435400,China;Department of Neurology,Wuxue First People's Hospital,Huanggang,Hubei,435400,China)

机构地区：[1]武穴市第一人民医院神经外科,湖北黄冈435400 [2]武穴市第一人民医院神经内科,湖北黄冈435400

出　　处：《当代医学》2024年第20期129-133,共5页Contemporary Medicine

摘　　要：目的探讨蛛网膜下腔出血后(subarachnoid hemorrhage,SAH)迟发性缺血性神经功能缺损(delayed ischemic neurological deficits,DIND)的危险因素。方法回顾性分析2018年1月至2021年12月武穴市第一人民医院收治的210例蛛网膜下腔出血患者的临床资料,根据手术的不同分为手术夹闭(surgical clamping,SC)组与血管内介入栓塞(endovascular interventional embolization,EC)组,采用单因素及多因素Logistic回归分析DIND的危险因素。结果210例SAH患者中96例接受SC治疗,114例接受EC治疗。EC组年龄、世界神经外科医师联盟(World Federation of Neurosurgical Societies,WFNS)分级5级占比、脑室出血占比、动脉瘤部位为基底动脉(basilar artery,BA)和椎动脉(vertebral artery,VA)占比、尼莫地平使用率、抗血小板使用率均高于SC组,动脉瘤大小大于SC组,瘤颈宽度宽于SC组,脑内血肿占比、动脉瘤部位为大脑中动脉(middle cerebral artery,MCA)占比均低于SC组,差异有统计学意义(P<0.05)。经脑血管造影或经颅多普勒确诊症状性脑血管痉挛(symptomatic vasospasm,SV)患者31例(14.76%),未发生SV患者179例(85.24%),单因素分析结果显示,SV患者SC、女性、糖尿病、颈内动脉(internal carotid artery,ICA)动脉瘤、未使用尼莫地平和出血性性并发症占比均高于未发生SV患者,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,ICA动脉瘤、出血性并发症、未使用尼莫地平和SC是DIND发生的危险因素(P<0.05)。结论ICA动脉瘤、治疗策略、出血性并发症和尼莫地平的应用与DIND相关,使用尼莫地平和避免出血性并发症是预防DIND发生的有效方法。Objectives To explore the risk factors of delayed ischemic neurological deficits(DIND)after subarachnoid hemorrhage(SAH).Methods The clinical data of 210 patients with subarachnoid hemorrhage admitted to the Wuxue First People's Hospital from January 2018 to December 2021 were retrospectively analyzed,and the patients were divided into the surgical clamping(SC)group and the endovascular interventional embolization(EC)group according to the different procedures,univariate and multivariate Logistic regression analysis were used to determine the risk factors of DIND.Results A total of 210 cases of SAH were evaluated,of which 96(45.71%)were treated with SC and 114(54.29%)with EC.The proportion of age,WFNS grade 5,ventricular hemorrhage,aneurysm site basilar artery(BA)and vertebral artery(VA),nimodipine usage rate and antiplatelet usage rate in the EC group were higher than those in the SC group,the size of aneurysm was larger than that in the SC group,the neck width was wider than that in the SC group,the proportion of intracranial hematoma and aneurysm site middle cerebral artery(MCA)was lower than that in the SC group,and the differences were statistically significant(P<0.05).31 cases(14.76%)with symptomatic vasospasm(SV)was diagnosed by cerebral angiography or transcranial Doppler,and 179 cases(85.24%)without SV.The results of univariate analysis showed that the percentages of SC,female,diabetes,internal carotid artery(ICA)aneurysm and bleeding complications of patients with SV were higher than thoes of patients without SV,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that ICA aneurysm,bleeding complications,non-use of nimodipine and SC were risk factors for DIND(P<0.05).Conclusion ICA aneurysm,treatment strategies,hemorrhagic complications and nimodipine administration were associated with DIND,the use of nimodipinel and avoiding hemorrhagic complications were effective methods to prevent DIND.

关 键 词：迟发性缺血性神经功能障碍 手术夹闭 血管内介入栓塞 尼莫地平 

分 类 号：R74[医药卫生—神经病学与精神病学]