心电图改变与动脉瘤性蛛网膜下腔出血后脑血管痉挛的相关性研究
发布时间：2019-04-04 10:25
【摘要】：目的：脑血管痉挛（cerebral vasospasm，CVS）是动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage，aSAH）的严重并发症之一，也是其致残及致死的主要原因，严重影响着患者的预后。目前对于CVS的发病机制尚未完全阐明。近年来，国外研究发现交感神经的病理性亢进的机制可能与CVS的发生有关，同时中枢交感神经活性的增加可能跟aSAH后心电图的异常有关。为进一步证实心电图异常跟血管痉挛之间存在关联，本研究回顾性的分析动脉瘤性蛛网膜下腔出血的患者早期心电图表现与脑血管痉挛之间的关联，并结合其他实验室及临床各项观测指标同时进行统计学分析，筛选出有显著相关的危险因素，从中观察心电图改变与血管痉挛之间的关联。进一步为降低aSAH后CVS的发病率，改善患者的预后提供相应的依据。 方法：选取河北医科大学附属第二医院神经外科在2012年6月至2013年9月期间收治的193例颅内动脉瘤破裂所致的蛛网膜下腔出血患者，对出血后24小时内心电图表现及其他临床及实验室观测指标与脑血管痉挛之间的关系进行回顾性的分析。并对患者进行了6个月的随访。统计方法采用SPSS18.0统计分析软件进行分析，对数据行单因素卡方检验及多因素Logistic回归分析，检验水准P=0.05。 结果：193例患者中66例发生CVS，发病率为34.2%。共128例患者出现了不同程度的心电图异常改变，经单因素卡方检验及多因素Logistic回归分析，QT间期延长为脑血管痉挛发生的独立危险因素（OR=8.304,95%CI：3.624~19.025）,其他心电图异常表现对脑血管痉挛的发病率差异无统计学意义（p㧐0.05）。临床及实验室观测指标中，有吸烟史(OR=5.743，95%CI：2.373~13.897)、低钠血症（OR=2.038,95%CI:1.065~3.902）、WFNS分级"gⅣ级（OR=2.820,95%CI：1.204~6.604）、Fisher分级"g3级（OR=3.369,95%CI:1.372~8.271）均为脑血管痉挛发生的独立危险因素。白细胞计数及手术时机为脑血管痉挛发生的危险因素（p㩳0.05）。对患者进行6个月随访，共死亡33(17.1%)例，重残患者共32(16.6%)例，进行分组后计算，结果显示发生脑血管痉挛的患者，残疾率及死亡率均明显升高(P0.05)。 结论：1动脉瘤性蛛网膜下腔出血的患者早期心电图中QT间期延长是脑血管痉挛发生的独立危险因素，，QT间期延长的患者脑血管痉挛的发病率明显高于QT间期正常的患者。2有吸烟史、低钠血症、WFNS分级"gⅣ级、Fisher分级"g3级为动脉瘤性蛛网膜下腔出血后脑血管痉挛的独立预测因素，应密切监测，积极预防及治疗。白细胞计数增高为脑血管痉挛的危险因素，检测患者的白细胞计数有助于脑血管痉挛的早期诊断及治疗。3动脉瘤性蛛网膜下腔出血的患者宜于出血后三天内早期行手术治疗。4发生脑血管痉挛的患者预后较差，致死率及致残率明显升高，应早期给予积极治疗。
[Abstract]:Aim: cerebral vasospasm (cerebral vasospasm,CVS) is one of the serious complications of aneurysm subarachnoid hemorrhage (aneurysmal subarachnoid hemorrhage,aSAH). It is also the main cause of disability and death, which seriously affects the prognosis of patients. At present, the pathogenesis of CVS has not been fully clarified. In recent years, studies abroad have found that the mechanism of pathological hyperactivity of sympathetic nerve may be related to the occurrence of CVS, and the increase of central sympathetic nerve activity may be related to abnormal electrocardiogram after aSAH. To further confirm the association between abnormal electrocardiogram and vasospasm, this study retrospectively analyzed the association between early ECG manifestations and cerebral vasospasm in patients with aneurysm subarachnoid hemorrhage. Combined with other laboratory and clinical observations, statistical analysis was carried out at the same time to screen out the risk factors with significant correlation, from which to observe the relationship between ECG changes and vasospasm. To further reduce the incidence of CVS after aSAH and improve the prognosis of the patients to provide the corresponding basis. Methods: 193 patients with subarachnoid hemorrhage caused by ruptured intracranial aneurysm were selected from the neurosurgery department of the second affiliated Hospital of Hebei Medical University from June 2012 to September 2013. The relationship between 24-hour electrocardiogram (EMG) and other clinical and laboratory observations and cerebral vasospasm (CVS) was analyzed retrospectively. The patients were followed up for 6 months. The statistical methods were analyzed by SPSS18.0 statistical analysis software. The single factor chi-square test and multi-factor Logistic regression analysis were used to test the level of P0. 05. Results: the incidence of CVS, in 66 of 193 patients was 34.2%. After univariate chi-square test and multi-factor Logistic regression analysis, the prolongation of QT interval was an independent risk factor (OR=8.304,95%CI:3.624~19.025) for the occurrence of cerebral vasospasm. There was no significant difference in the incidence of cerebral vasospasm between other abnormal ECG manifestations (p < 0.05). Among the clinical and laboratory indexes, smoking history (OR=5.743,95%CI:2.373~13.897), hyponatremia (OR=2.038,95%CI:1.065~3.902), WFNS grade "g鈪
本文编号：2453724
[Abstract]:Aim: cerebral vasospasm (cerebral vasospasm,CVS) is one of the serious complications of aneurysm subarachnoid hemorrhage (aneurysmal subarachnoid hemorrhage,aSAH). It is also the main cause of disability and death, which seriously affects the prognosis of patients. At present, the pathogenesis of CVS has not been fully clarified. In recent years, studies abroad have found that the mechanism of pathological hyperactivity of sympathetic nerve may be related to the occurrence of CVS, and the increase of central sympathetic nerve activity may be related to abnormal electrocardiogram after aSAH. To further confirm the association between abnormal electrocardiogram and vasospasm, this study retrospectively analyzed the association between early ECG manifestations and cerebral vasospasm in patients with aneurysm subarachnoid hemorrhage. Combined with other laboratory and clinical observations, statistical analysis was carried out at the same time to screen out the risk factors with significant correlation, from which to observe the relationship between ECG changes and vasospasm. To further reduce the incidence of CVS after aSAH and improve the prognosis of the patients to provide the corresponding basis. Methods: 193 patients with subarachnoid hemorrhage caused by ruptured intracranial aneurysm were selected from the neurosurgery department of the second affiliated Hospital of Hebei Medical University from June 2012 to September 2013. The relationship between 24-hour electrocardiogram (EMG) and other clinical and laboratory observations and cerebral vasospasm (CVS) was analyzed retrospectively. The patients were followed up for 6 months. The statistical methods were analyzed by SPSS18.0 statistical analysis software. The single factor chi-square test and multi-factor Logistic regression analysis were used to test the level of P0. 05. Results: the incidence of CVS, in 66 of 193 patients was 34.2%. After univariate chi-square test and multi-factor Logistic regression analysis, the prolongation of QT interval was an independent risk factor (OR=8.304,95%CI:3.624~19.025) for the occurrence of cerebral vasospasm. There was no significant difference in the incidence of cerebral vasospasm between other abnormal ECG manifestations (p < 0.05). Among the clinical and laboratory indexes, smoking history (OR=5.743,95%CI:2.373~13.897), hyponatremia (OR=2.038,95%CI:1.065~3.902), WFNS grade "g鈪
本文编号：2453724
本文链接：https://www.wllwen.com/yixuelunwen/shenjingyixue/2453724.html
最近更新
教材专著
