动脉瘤性蛛网膜下腔出血后迟发性缺血性神经功能障碍的相关因素分析

发布时间：2018-06-21 22:16

本文选题：动脉瘤 + 蛛网膜下腔出血　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:通过回顾性病例分析,筛选出与迟发性缺血性神经功能障碍(delayed ischemic neurological deficit,DIND)发生显著相关的危险因素,并及时的采取措施进行干预,以期提高动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)的治疗效果及改善患者的预后。方法:收集山西医科大学附属大医院神经外科2014年3月至2016年9月收住院治疗的127例aSAH患者的临床资料及随访结果。回顾性分析患者的年龄、性别、吸烟史、脑血管痉挛情况、入院时血压、心电图、白细胞计数、血浆D-二聚体、动脉瘤位置、GCS评分、临床分级、Fisher分级等18项相关因素,并随访3个月,按照GOS评分评估预后。根据是否发生DIND分组,分为DIND组和非DIND组,采用SPSS22.0统计软件,分别对上述因素进行统计描述和影响因素分析,最终确定其发生的危险因素。结果:127例患者中发生迟发性缺血性神经功能障碍的共30例,占23.6%,其中男15例,女15例,男女比例1:1,年龄最小的35岁,最大年龄78岁,平均年龄(53.47±10.76)岁。单因素分析结果显示吸烟史、脑血管痉挛情况、心电图、GCS评分、临床分级及Fisher分级差异具有统计学意义(P㩳0.05),提示他们可能是DIND的危险因素。进一步行Logistic回归分析发现吸烟史(OR=0.153,95%CI 0.050-0.466)、脑血管痉挛情况(OR=3.407,95%CI 1.202-9.655)和Fisher分级(OR=6.113,95%CI2.157-17.323)为预示迟发性缺血性神经功能障碍发生的独立危险因素,即有吸烟史、脑血管痉挛和Fisher分级高的患者易发生DIND。经过3个月的随访,结果显示死亡、植物生存和重度残疾的患者达24例,而轻度残疾和恢复良好的患者仅有6例,可以看出发生DIND后,患者的致残、致死率明显升高。结论:aSAH后DIND的发生是多因素综合作用的结果;有吸烟史、脑血管痉挛和Fisher分级高的患者易发生DIND;发生DIND后,患者通常预后不良,应积极防治。
[Abstract]:Objective: to screen out the risk factors associated with delayed ischemic neurological dysfunction (delayed ischemic neurological deficittii Dind) by retrospective analysis, and to take measures to intervene in time. In order to improve the therapeutic effect and improve the prognosis of patients with aneurysm subarachnoid hemorrhage (aneurysmal subarachnoid hemia aSAH). Methods: the clinical data and follow-up results of 127 patients with aSAH admitted from March 2014 to September 2016 in neurosurgery Department of affiliated Hospital of Shanxi Medical University were collected. Age, sex, smoking history, cerebral vasospasm, blood pressure at admission, electrocardiogram, white blood cell count, plasma D-dimer, GCS score of aneurysm location, clinical grade and Fisher grade were retrospectively analyzed. The patients were followed up for 3 months to evaluate the prognosis according to the GOS score. According to whether Dind occurred or not, it was divided into two groups: Dind group and non-DIND group. SPSS22.0 statistical software was used to describe the above factors and analyze the influencing factors, and finally to determine the risk factors. Results among 127 cases, 30 cases (23.6%) had delayed ischemic neurological dysfunction, including 15 males and 15 females, the ratio of male to female was 1: 1, the youngest was 35 years old, the maximum age was 78 years, the average age was (53.47 卤10.76) years. Univariate analysis showed that there were significant differences in smoking history, cerebral vasospasm, GCS score of electrocardiogram, clinical grade and Fisher grade (P 0.05), suggesting that they may be risk factors of DIND. Logistic regression analysis showed that smoking history (ORO 0.153 CI 0.050-0.466), cerebral vasospasm (ORT 3.40795 CI 1.202-9.655) and Fisher grade (OR6.11395CI2.157-17.323) were independent risk factors for predicting delayed ischemic neurological dysfunction, that is, smoking history. Patients with cerebral vasospasm and high Fisher grade were prone to DIND. Following up for 3 months, 24 patients died, vegetative survival and severe disability were found, but only 6 patients with mild disability and good recovery. It can be seen that after DIND, the disability and mortality of the patients increased significantly. Conclusion the occurrence of DIND is the result of multiple factors, the patients with smoking history, cerebral vasospasm and Fisher grade are prone to DIND.The patients with DIND usually have poor prognosis and should be actively prevented from DIND.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.35

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