动脉瘤性蛛网膜下腔出血后慢性脑积水形成及预后的影响因素研究

发布时间：2018-05-13 13:15

本文选题：动脉瘤性蛛网膜下腔出血 + 脑积水　；参考：《浙江大学》2014年硕士论文

【摘要】：目的分析动脉瘤性蛛网膜下腔出血(aSAH)后慢性脑积水形成的危险因素,并进一步探讨危险因素对慢性脑积水患者行脑室-腹腔分流术(VPS)预后的影响,旨在病因学和治疗学两方面上提高患者的整体预后。方法回顾性收集2009年6月至2012年6月间我院收治的202例aSAH病人临床病例资料,根据有无慢性脑积水分为脑积水组与无脑积水组；对脑积水组行VPS患者随访6个月至2年,根据随访结果分为有效组与无效组。利用单因素分析方法(卡方检验、秩和检验、Fisher精确检验等)及多因素分析方法(Logistic回归法)对危险因素和预后因素进行对比分析。结果aSAH后慢性脑积水的发生率为27.2%(55/202)。单因素分析中,年龄、高血压、格拉斯哥评分(GCS)、 Hunt-Hess分级、Fisher分级、动脉瘤位置、出血次数、急性脑积水、血肿位置、脑室外引流(EVD)及引流时间、手术方式、去骨瓣减压术(DC)、脑血管痉挛和颅内感染(ICI)具有统计学意义(P0.05)；多因素分析显示高龄、高血压史、后循环动脉瘤、急性脑积水、脑室内血肿(IVH)、VD及EVD时间是独立危险因素。40例行VPS慢性脑积水患者完成随访,26例术后病情好转(65%)；年龄、GCS、Hunt-Hess分级、EVD时间、ICI对VPS预后有显著性影响。结论aSAH后慢性脑积水的形成与多重因素相关,其中高龄、入院时脑神经功能较差、EVD及EVD时间较长、ICI等不仅可提示易形成慢性脑积水,同时还可预测VPS的预后。对具备上述因素的aSAH患者给予及时适当的处理,可改善该部分病人的整体预后。
[Abstract]:Objective to analyze the risk factors of chronic hydrocephalus after aneurysm subarachnoid hemorrhage (SAH) and to explore the influence of risk factors on the prognosis of VPS in patients with chronic hydrocephalus. The aim is to improve the overall prognosis of patients both in etiology and therapeutics. Methods the clinical data of 202 patients with aSAH from June 2009 to June 2012 were retrospectively collected and divided into hydrocephalus group and non-hydrocephalus group according to chronic hydrocephalus, followed up for 6 months to 2 years in hydrocephalus group. According to the results of follow-up, they were divided into effective group and ineffective group. Single factor analysis (chi-square test, rank sum test, Fisher accurate test) and multivariate analysis method (logistic regression) were used to compare the risk factors and prognostic factors. Results the incidence of chronic hydrocephalus after aSAH was 27.2%. In univariate analysis, age, hypertension, Glasgow scale, Hunt-Hess grade, aneurysm location, bleeding times, acute hydrocephalus, hematoma location, ventricular drainage time, operative method, and so on. DCI, cerebral vasospasm and intracranial infection (ICI) had statistical significance (P 0.05). Multivariate analysis showed that age, history of hypertension, posterior circulatory aneurysm, acute hydrocephalus were found in the elderly, the history of hypertension, the posterior circulation aneurysm, and the acute hydrocephalus. VD and EVD time were independent risk factors in intraventricular hematoma. Forty patients with VPS chronic hydrocephalus were followed up and 26 patients with chronic hydrocephalus were followed up. Conclusion the formation of chronic hydrocephalus after aSAH is related to many factors. Among them, the elderly, the poor cerebral neurologic function and the longer EVD time can not only indicate the formation of chronic hydrocephalus, but also predict the prognosis of VPS. Timely and appropriate treatment of aSAH patients with these factors can improve the overall prognosis of these patients.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.34

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