动脉瘤性蛛网膜下腔出血再出血的危险因素分析

发布时间：2018-08-14 13:05

【摘要】：目的探讨动脉瘤性蛛网膜下腔出血(aneurysmal Subarachnoid Hemorrhage, aSAH)患者再出血的危险因素,为临床早期防治提供依据。方法回顾性分析2010年1月至2013年10月在天津市环湖医院神经外科住院的254例诊断为动脉瘤性蛛网膜下腔出血患者,其中28例(再发组)患者为住院期间再出血的病例,同期住院的226例(对照组)患者为住院期间未再出血的病例。对两组患者的有关危险因素进行比较。分析患者再出血与性别、年龄、干预时间、既往高血压病史、高脂血症病史、糖尿病病史、吸烟史、饮酒史、动脉瘤存在子囊及动脉瘤的部位、形态、大小和数量、Fisher分级、]Hunt-Hess分级、高血压分级及格拉斯哥预后(GOS)评分的关系。所得数据采用SPSS17.0统计软件进行统计学分析。结果 1.单因素分析显示两组患者在年龄、干预时间、动脉瘤存在子囊、动脉瘤大小、合并高等级的Fisher分级、H-H分级和高血压分级的比较,差异均具有统计学意义(P0.05)。 2.多因素Logistic回归分析显示高血压(2～3级)、高等级Fisher分级(Ⅲ～Ⅳ级)、高等级H-H分级(Ⅲ～Ⅴ级)、动脉瘤存在子囊、动脉瘤大小是动脉瘤性蛛网膜下腔出血患者再出血的独立危险因素(P0.05)。 3.两组患者在性别、既往存在高血压病史、高脂血症病史、糖尿病病史、吸烟、饮酒史以及动脉瘤的部位、形态和数量等方面差异均无统计学意义(P0.05)。 4.两组患者的GOS评分差异有统计学意义(P0.05),再发组患者GOS评分明显低于对照组患者。 5.再发组的病死率为42.9%(12/28),对照组的病死率为10.2%(23/226),两组之间差异有统计学意义(P0.05)。结论 1.高血压收缩压Fisher分级(Ⅲ～Ⅳ级)、H-H分级(Ⅲ～Ⅴ级)、动脉瘤存在子囊、动脉瘤直径≥10mm是再出血的独立危险因素。 2.动脉瘤性蛛网膜下腔出血患者早期手术或介入治疗能降低再出血率。 3.动脉瘤性蛛网膜下腔出血再出血会显著增加患者的病死率及致残率。
[Abstract]:objective
Objective To investigate the risk factors of rebleeding in patients with aneurysmal subarachnoid hemorrhage (aSAH), and to provide evidence for early clinical prevention and treatment.
Method
A retrospective analysis was made of 254 patients with aneurysmal subarachnoid hemorrhage admitted to the Department of Neurosurgery of Tianjin Huanhu Hospital from January 2010 to October 2013. Among them, 28 patients (recurrence group) had recurrent hemorrhage during hospitalization and 226 patients (control group) had no recurrent hemorrhage during hospitalization. Risk factors were compared. Rehaemorrhage and gender, age, intervening time, history of hypertension, hyperlipidemia, diabetes, smoking, drinking, location, shape, size and number of aneurysms with ascites and aneurysms, Fisher classification,]Hunt-Hess classification, hypertension classification and Glasgow Outcome (GOS) score were analyzed. The data were analyzed by SPSS17.0 statistical software.
Result
1. Univariate analysis showed that there were significant differences between the two groups in age, intervening time, aneurysm size, ascus, Fisher classification, H-H classification and hypertension classification (P 0.05).
2. Multivariate logistic regression analysis showed that hypertension (grade 2-3), higher Fisher classification (grade III-IV), higher H-H classification (grade III-V), and aneurysm with ascites were independent risk factors for aneurysmal subarachnoid hemorrhage (P 0.05).
3. There was no significant difference in gender, history of hypertension, hyperlipidemia, diabetes mellitus, smoking, drinking history, location, shape and number of aneurysms between the two groups (P 0.05).
4. There was significant difference in GOS score between the two groups (P 0.05). The GOS score of the relapse group was significantly lower than that of the control group.
5. The mortality of the relapse group was 42.9% (12/28) and that of the control group was 10.2% (23/226). The difference between the two groups was statistically significant (P 0.05).
conclusion
1. Fisher classification of hypertension systolic blood pressure (grade III-IV), H-H classification (grade III-V), aneurysm with ascus, aneurysm diameter (>10 mm) is an independent risk factor for rebleeding.
2. early surgery or interventional therapy for aneurysmal subarachnoid hemorrhage can reduce the rate of rebleeding.
3. the rebleeding of aneurysmal subarachnoid hemorrhage will significantly increase the mortality and disability rate of patients.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.35

【参考文献】