动脉瘤性蛛网膜下腔出血后迟发性脑缺血的危险因素分析

发布时间：2018-04-27 11:21

  本文选题：蛛网膜下腔出血 + 血清白蛋白　； 参考：《中国脑血管病杂志》2017年01期

【摘要】：目的探讨动脉瘤性蛛网膜下腔出血(a SAH)患者发生迟发性脑缺血(DCI)的危险因素。方法回顾性连续纳入2015年1月至2016年4月南京军区南京总医院神经外科收治的接受血管内介入治疗的a SAH患者106例,根据是否发生DCI,将患者分为DCI组(34例)与无DCI组(72例)。收集患者一般资料,包括性别、年龄、Hunt-Hess分级、改良Fisher分级、世界神经外科联盟(WFNS)分级、急性脑水肿、早期(出血1~3 d)低白蛋白血症、低血红蛋白血症等。进行单因素和多因素Logistic回归分析DCI发生的危险因素。结果 DCI发生率为32.1%(34/106)。DCI组Hunt-Hess分级≥Ⅲ级、改良Fisher分级≥Ⅲ级、WFNS分级≥Ⅳ级、急性脑水肿、低血红蛋白血症及低白蛋白血症的发生率均高于无DCI组,组间差异均有统计学意义(均P0.05);性别、年龄≥55岁、高血压病、糖尿病、低钠血症比例的组间差异均无统计学意义(均P0.05)。将单因素分析中Hunt-Hess分级≥Ⅲ级、改良Fisher分级≥Ⅲ级、入院WFNS分级≥Ⅳ级、低白蛋白血症作为自变量进行多因素分析,结果显示,入院WFNS分级≥Ⅳ级(OR=8.02,95%CI:2.41~26.70)、改良Fisher分级≥Ⅲ级(OR=4.44,95%CI:1.38~14.32)、1~3 d低白蛋白血症(OR=5.42,95%CI:1.40~20.76)是a SAH患者发生DCI的独立危险因素(均P0.05)。而Hunt-Hess分级≥Ⅲ级不是a SAH患者发生DCI的危险因素(OR=1.86,95%CI:0.39~8.88,P0.05)。结论 a SAH后低白蛋白血症、入院WFNS分级≥Ⅳ级、改良Fisher分级≥Ⅲ级是患者发生DCI的独立危险因素,临床诊治过程中应引起高度重视。
[Abstract]:Objective to investigate the risk factors of delayed cerebral ischemia (DCI) in patients with aneurysm subarachnoid hemorrhage (SAH). Methods from January 2015 to April 2016, 106 patients with a SAH received endovascular interventional therapy in the Department of Neurosurgery, Nanjing General Hospital of Nanjing military region, Nanjing military region. According to the occurrence or not, the patients were divided into DCI group (n = 34) and no DCI group (n = 72). General data of patients were collected, including sex, age, Hunt-Hess grade, modified Fisher classification, WFS classification, acute cerebral edema, early (1 to 3 days) hypoalbuminemia, hypohemoglobinemia and so on. The risk factors of DCI were analyzed by univariate and multivariate Logistic regression analysis. Results the incidence of DCI in 32.1%(34/106).DCI group was higher than that in 32.1%(34/106).DCI group, Hunt-Hess grade 鈮，

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