术前格拉斯哥昏迷量表评分、白蛋白与纤维蛋白原比值与动脉瘤性蛛网膜下腔出血患者术后转归关系研究  

Relationship between preoperative GCS scores,AFR and postoperative outcomesin patients with aneurysmal subarachnoid hemorrhage

作　　者：黎莎 张占伟[1] 胡烨 胡潘 廖若夷[1] LI Sha;ZHANG Zhanwei;HU Ye;HU Pan;LIAO Ruoyi(Department of Neurosurgery,the First Hospital of Hunan University of Chinese Medicine,Changsha 410007,China)

机构地区：[1]湖南中医药大学第一附属医院神经外科,湖南长沙410007

出　　处：《陕西医学杂志》2025年第2期209-213,共5页Shaanxi Medical Journal

基　　金：湖南省教育厅科学研究项目(22A0248)。

摘　　要：目的:探讨术前格拉斯哥昏迷量表(GCS)评分、白蛋白与纤维蛋白原比值(AFR)与动脉瘤性蛛网膜下腔出血(SAH)患者术后转归的关系。方法:选取行手术治疗的动脉瘤性SAH患者87例。术后3个月,采用改良Rankin量表(mRS)评估患者术后转归情况,并将患者分为转归良好组(56例)和转归不良组(31例)。检测血清白蛋白、纤维蛋白原水平,并计算AFR。比较两组临床资料以及术前GCS评分、AFR水平。采用Logistic回归分析动脉瘤性SAH患者术后转归的影响因素。绘制受试者工作特征(ROC)曲线分析术前GCS评分、AFR对动脉瘤性SAH患者术后转归不良的预测价值。结果:转归不良组年龄大于转归良好组(P<0.05)。转归不良组原发性高血压病史、Hunt-Hess分级Ⅳ-Ⅴ级、改良Fisher分级Ⅲ-Ⅳ级、术后肺部感染以及术后脑出血比例高于转归良好组(均P<0.05)。转归不良组术前GCS评分、AFR水平低于转归良好组(均P<0.05)。原发性高血压病史、Hunt-Hess分级、改良Fisher分级、术后肺部感染、术后脑出血、术前GCS评分、术前AFR为动脉瘤性SAH患者术后转归的独立影响因素(均P<0.05)。术前GCS评分、AFR以及两者联合预测动脉瘤性SAH患者术后3个月转归不良的曲线下面积(AUC)分别为0.852、0.867、0.926,且联合检测的AUC更高(均P<0.05)。结论:术前GCS评分、AFR是动脉瘤性SAH患者术后转归的独立影响因素,且能够预测患者术后转归情况,两者联合具有更高的预测价值。Objective:To explore the relationship between preoperative Glasgow Coma Scale(GCS)scores,albumin-to-fibrinogen ratio(AFR)and postoperative outcomes in patients with aneurysmal subarachnoid hemorrhage(SAH).Methods:A total of 87 patients with aneurysmal SAH who underwent surgical treatment were selected.At three months postoperatively,patient outcomes were assessed using the modified Rankin Scale(mRS),and patients were divided into a good outcome group(56 cases)and a poor outcome group(31 cases).Serum albumin and fibrinogen levels were measured,and AFR was calculated.Clinical data,preoperative GCS scores and AFR levels were compared between the two groups.Logistic regression was used to analyze the influencing factors of postoperative outcomes in patients with aneurysmal SAH.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of preoperative GCS score and AFR for poor postoperative outcome in patients with aneurysmal SAH.Results:The poor outcome group was older than the good outcome group(P<0.05).The poor outcome group had a higher proportion of patients with a history of primary hypertension,Hunt-Hess gradeⅣ-Ⅴ,modified Fisher gradeⅢ-Ⅳ,postoperative pulmonary infection,and postoperative cerebral hemorrhage compared to the good outcome group(all P<0.05).Preoperative GCS scores and AFR levels were lower in the poor outcome group than those in the good outcome group(all P<0.05).A history of primary hypertension,Hunt-Hess grade,modified Fisher grade,postoperative pulmonary infection,postoperative cerebral hemorrhage,preoperative GCS scores,and preoperative AFR were independent factors affecting postoperative outcomes in patients with aneurysmal SAH(all P<0.05).The area under the curve(AUC)of preoperative GCS score,AFR,and their combination for predicting poor outcome in patients with aneurysmal SAH at 3 months after surgery was 0.852,0.867 and 0.926,respectively,and the AUC of combined detection was higher(all P<0.05).Conclusion:Preoperative GCS score and AFR are independent in

关 键 词：动脉瘤性蛛网膜下腔出血 格拉斯哥昏迷量表 白蛋白与纤维蛋白原比值 术后转归 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]