血红蛋白浓度与aSAH外科治疗后症状性脑血管痉挛的相关性研究

发布时间：2018-06-08 12:48

本文选题：颅内动脉瘤 + 蛛网膜下腔出血　；参考：《重庆医科大学》2014年硕士论文

【摘要】：目的探讨血液中血红蛋白浓度对动脉瘤性蛛网膜下腔出血患者外科治疗后症状性脑血管痉挛发生的影响。方法回顾性分析218动脉瘤破裂后行外科手术治疗患者的病案资料，包括一般资料、手术方式、术中动脉瘤是否破裂、入院时Hunt-hess分级等。对动脉瘤破裂后的初次CT结果进行发发Fisher分级，详细记录患者术后测得的血红蛋白浓度并计算其平均值，将每个患者术后的平均血红蛋白浓度分为110g/L以下、110-120g/L、120-130g/L、130g/L以上四个等级。先对可能影响症状性脑血管痉挛的因素进行单因素分析，，再将单因素分析有统计学意义的因素纳入多因素逐步logistic回归分析。结果 1单因素分析提示入院时Hunt-hess分级、术中是否破裂、CTFisher分级、术后平均血红蛋白浓度与患者术后症状性脑血管痉挛的发生显著相关（P0.05）。 2多因素分析提示在调整了入院时Hunt-hess分级、CTFisher分级混杂作用后，术后平均血红蛋白浓度与症状性脑血管痉挛的发生显著相关，与其它各等级相比，术后平均血红蛋白浓度在110-120g/L的患者症状性脑血管痉挛发生率最低（OR=3.293、3.633、5.336，P0.05）。结论血红蛋白浓度是动脉瘤性蛛网膜下腔出血患者外科治疗后症状性脑血管痉挛的一个独立危险因素，维持血红蛋白浓度在一定水平有利于减少患者术后症状性脑血管痉挛的发生。
[Abstract]:Objective to investigate the effect of hemoglobin concentration in blood on the occurrence of symptomatic cerebral vasospasm after surgical treatment in patients with aneurysm subarachnoid hemorrhage. General data, surgical procedures, intraoperative rupture of aneurysms, Hunt-hess grading on admission, etc. The initial CT results of ruptured aneurysms were classified by Fisher grade. The hemoglobin concentrations were recorded and calculated in detail. The mean hemoglobin concentrations of each patient were divided into four grades below 110-120 g / L, 120-130 g / L, 130 g / L and below 110 g / L, respectively. Univariate analysis was carried out to analyze the factors that might affect symptomatic cerebral vasospasm, and then the factors with statistical significance in univariate analysis were included in multivariate stepwise logistic regression analysis. Results 1 single factor analysis suggested Hunt-hess grade on admission. There was a significant correlation between postoperative mean hemoglobin concentration and the occurrence of symptomatic cerebral vasospasm (P 0.05). 2 multivariate analysis showed that after adjusting the mixed effect of Hunt-hess grade and CTFisher grade on admission, the mean hemoglobin concentration was significantly correlated with the occurrence of symptomatic cerebral vasospasm. The mean hemoglobin concentration was significantly correlated with the occurrence of symptomatic cerebral vasospasm, compared with other grades. The incidence of symptomatic cerebral vasospasm was the lowest in patients with postoperative mean hemoglobin concentration of 110-120 g / L. Conclusion hemoglobin concentration is an independent risk factor for symptomatic cerebral vasospasm after surgical treatment in patients with aneurysm subarachnoid hemorrhage. Maintaining hemoglobin concentration at a certain level can reduce the incidence of symptomatic cerebral vasospasm after operation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.35

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