影响动脉瘤性蛛网膜下腔出血出血量的因素研究

发布时间：2018-03-08 01:24

本文选题：动脉瘤　切入点：蛛网膜下腔出血　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:动脉瘤性蛛网膜下腔出血(aSAH)是一种高发病率和高死亡率的急性脑血管疾病。发病后的神经功能缺失与aSAH的出血量是存在显著相关性的,我们一般使用改良fisher分级来衡量aSAH出血量的多少。在动脉瘤性蛛网膜下腔出血病例中,发病后死亡率及病残率与出血量存在相关性,探寻aSAH后出血量与疾病的死残率之间的关系,从社会公共健康的角度来说研究决定aSAH出血量的风险因素是十分重要的。方法:本研究选取了155个aSAH患者来研究可能导致aSAH出血量增加的相关危险因素,其中包括:人口统计学因素,既往病史,院前血压水平和动脉瘤的特征。我们对入组的患者进行分析研究并如实记录了以下的相关数据:1易感的危险因素诸如性别,年龄,吸烟,高血压及糖尿病;2院前血压水平(特制患者在动脉瘤破裂之后,在使用口服或者静脉降压药物治疗之前的血压水平),包括院前的收缩、舒张压和脉压;3破裂动脉的相关特征,包括动脉瘤的形态,大小,位置(细分为颈内动脉动脉瘤,前交通动脉动脉瘤,大脑中动脉动脉瘤,大脑后动脉动脉瘤,大脑前动脉动脉瘤,基底动脉动脉瘤,小脑后下动脉动脉瘤,小脑前下动脉动脉瘤,椎动脉动脉瘤),动脉瘤的总数目(单一患者),动脉瘤体的最大直径,动脉瘤颈的直径及动脉瘤体颈比。我们选取了性别,年龄,高血压,糖尿病,吸烟,院前血压的收缩压,院前血压的舒张压,院前血压的脉压,动脉瘤的形态,数目,位置,瘤体最大直径,瘤颈最大直径,体颈比作为分别独立的自变量。用改良fisher分级水平作为因变量。使用SAS9.2统计软件进行统计分析。结果:对危险因素的单因素分析结果1单个患者颅内动脉瘤的数目与发病后改良fisher分级有重要的关系(grade 3-4;P=0.016)。颅内多发动脉瘤(2-4个)是可能导致较高的改良fisher分级的重要原因([OR]=4.0,P=0.004)。2位于颈内动脉、前交通动脉及大脑中动脉的动脉瘤相对于其他部位动脉瘤是导致较高的改良fisher分级的重要危险因子(P0.001)。前交通动脉动脉瘤破裂出血与较高的改良Fisher分级存在重要的相关性(OR=4.3,P=0.025)。3患者院前血压的舒张压(DBP)较高是可能导致发病后较高的改良Fisher分级的危险因素(P=0.024)。对危险因素的多因素分析结果1研究发现前交通动脉瘤动脉瘤破裂出血与更高的改良fisher分级存在重要的相关性([OR]=4.3,P=0.025),颈内动脉动脉瘤破裂出血与发病后改良fisher分级0-2级关系是成反比的(OR=0.6,P0.001))。2患者患有多个动脉瘤(2-4)是发病后造成更高的改良fisher分级的重要危险因素(OR=4.0,P=0.004)。相反的,单发大脑中动脉动脉瘤破裂出血,在对于造成更高的改良fisher分级没有统计学意义(OR=4.1)。3尽管较高的院前舒张压水平与与发病后更高的改良fisher分级存在重要的相关性(P=0.047),但这并不能作为独立的临床相关危险因素(OR=1.0)。结论:院前血压的舒张压(DBP),颅内多发动脉瘤和前交通动脉动脉瘤与蛛网膜下腔出血出发病后血量较多存在明显的相关性。具有以上特征的动脉瘤患者应该给予早期干预和治疗以预防相关危险的发生。
[Abstract]:Objective: aneurysmal subarachnoid hemorrhage (aSAH) is a kind of high incidence and high mortality of acute cerebral vascular disease. The amount of bleeding and loss of nerve function after the onset of aSAH is significant correlation, we generally use the modified Fisher grade aSAH to measure the amount of bleeding in aneurysmal subarachnoid space. After the onset of subarachnoid hemorrhage cases, the mortality rate and disability rate and the amount of bleeding are correlated to explore the relationship between the aSAH and the amount of bleeding disease the rate of death and disability, from the public health perspective on the decision risk factors for aSAH hemorrhage is very important. Methods: This study selected 155 aSAH patients to study may lead to increased risk factors, aSAH hemorrhage including: demographic factors, medical history, characteristics of the level of blood pressure and artery aneurysm before hospital. We enrolled patients as research and analysis The real record of the relevant data of the following: 1 susceptible risk factors such as gender, age, smoking, hypertension and diabetes; 2 pre hospital blood pressure level (after rupture of aneurysm in special patients before using oral or intravenous antihypertensive treatment, blood pressure levels) including pre hospital contraction, diastolic pressure and pulse pressure; 3 characteristics of artery rupture, including aneurysm morphology, size, location (subdivided into internal carotid artery aneurysm, aneurysm of anterior communicating artery, middle cerebral artery aneurysms and aneurysms of the posterior cerebral artery, anterior cerebral artery aneurysm, basilar artery aneurysms and aneurysms of the posterior inferior cerebellar artery, anterior inferior cerebellar artery aneurysm of vertebral artery aneurysm), the total number of aneurysms (single patients), the maximum diameter of the aneurysm, the aneurysm diameter and carotid artery aneurysm neck ratio. We selected the gender, age, hypertension, diabetes, smoking, blood pressure before the hospital The systolic pressure, diastolic blood pressure and pre hospital, hospital blood pressure pulse pressure, arterial aneurysm morphology, number, location, tumor diameter, the largest diameter of aneurysm neck, neck and body respectively than as independent variable. Using the modified Fisher grade level as the dependent variable. The statistical analysis was performed using SAS9.2 statistical software. Results: the single factor analysis on risk factors of the number 1 single intracranial artery tumor patients with the onset of the modified Fisher grading has an important relationship (grade 3-4; P=0.016). Multiple intracranial aneurysms (2-4) may be important factors leading to higher grade of the modified Fisher ([OR]=4.0, P=0.004).2 is located in the internal carotid artery, artery aneurysms of the anterior communicating artery and middle cerebral artery aneurysms compared to other parts is an important risk factor which lead to improved Fisher high grade (P0.001). The anterior communicating artery aneurysm rupture and modified Fisher grade high significant Correlation (OR=4.3, P=0.025).3 in patients with diastolic blood pressure (DBP) is high may lead to the danger of modified Fisher high grade factors after onset (P=0.024). Multiple factor analysis on the risk factors of the study found that 1 aneurysms of anterior communicating artery aneurysm rupture and modified Fisher grade higher significant correlation ([OR]=4.3, P=0.025), internal carotid artery aneurysm rupture and bleeding after the onset of the modified Fisher grade 0-2 level is inversely proportional to the relationship (OR=0.6, P0.001).2) in patients with multiple intracranial aneurysms (2-4) is an important risk caused by the modified Fisher grade higher after the onset of the factors (OR=4.0, P=0.004) instead. Solitary, ruptured middle cerebral artery aneurysms, there was no statistical significance in the modified Fisher grade for the cause of higher.3 (OR=4.1) despite the higher pre hospital diastolic blood pressure level and the modified Fisher grade after the onset and higher being important The correlation (P=0.047), but this is not an independent clinical risk factors (OR=1.0). Conclusion: the diastolic blood pressure (DBP), and multiple intracranial aneurysms of anterior communicating artery aneurysms with subarachnoid hemorrhage volume there are more obvious correlation of aneurysm patients after onset. With the above characteristics should be given early intervention and treatment to prevent the occurrence of the risk.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.35

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