脑脊液乳酸浓度与颅内动脉瘤夹闭术后预后的相关性研究

发布时间：2018-11-04 12:00

【摘要】：目的:研究动脉瘤夹闭术后患者脑脊液乳酸(CSFL)浓度与蛛网膜下腔出血量、Hunt-Hess分级、GCS评分、GOS评分及并发症的发生之间的关系,探讨CSFL浓度与动脉瘤夹闭术后患者预后的关系。方法:通过利用血气分析仪对颅内动脉瘤开颅夹闭术后患者不同时间同时进行血和CSFL浓度的检测,以及对患者术后随访6月,并行GOS评分。统计分析CSFL浓度与蛛网膜下腔出血量、GCS评分、Hunt-Hess分级、GOS评分之间的关系,并观察血与脑脊液中乳酸浓度是否存在相关性,术后动态复查头颅CT,观察有无脑积水、脑梗死等并发症表现,并根据CSFL浓度进行分组,统计各组并发症发生的差异。结果:?CSFL浓度与蛛网膜下腔出血量Pearson相关系数(r=0.638,P=0.0000.001(双侧检验));?CSFL浓度与GOS评分之间Pearson相关系数为(r=-0.794,P=0.0000.001(双侧));?CSFL浓度与GCS评分之间Pearson相关系数为(r=-0.752,P=0.0000.001(双侧));④CSFL浓度与Hunt-Hess分级之间Pearson相关系数为(r=0.694,P=0.0000.001(双侧));⑤无并发症组的CSFL浓度(2.09±0.47)mmol/L,并发症组的CSFL浓度(3.52±1.17)mmol/L,两组之间t检验P=0.0000.001,存在明显统计学差异;⑥血乳酸浓度变化与CSFL浓度相关,但血乳酸浓度值位于正常范围内;⑦当CSFL浓度3.0mmol/L时,并发症明显增加,而预后明显变差。结论:1、CSFL浓度与动脉瘤破裂出血后蛛网膜下腔出血量、GOS、Hunt-Hess分级、GCS评分及并发症的发生等显著相关,FISHER分级越高,Hunt-Hess分级越高,CSFL浓度越高,预后越差。CSFL浓度可作为颅内动脉瘤术后早期评价预后的一项参考指标;2、CSFL浓度轻度升高(≤3.0mmol/L)时,预后无明显统计学意义,CSFL浓度明显升高(3.0mmol/L)时,预后明显变差。
[Abstract]:Objective: to study the relationship between cerebrospinal fluid lactate (CSFL) concentration and subarachnoid hemorrhage, Hunt-Hess grade, GCS score, GOS score and complications after aneurysm clipping. To investigate the relationship between the concentration of CSFL and the prognosis of patients after aneurysm clipping. Methods: blood and CSFL concentrations were measured at different times after intracranial aneurysm clipping by blood gas analyzer. The patients were followed up for 6 months with GOS score. The relationship between the concentration of CSFL and subarachnoid hemorrhage, GCS score, Hunt-Hess grade, GOS score was analyzed statistically, and the correlation between blood and cerebrospinal fluid lactate concentration was observed. Complications such as cerebral infarction were divided into groups according to the concentration of CSFL. Results: the Pearson correlation coefficient between CSFL concentration and subarachnoid hemorrhage was 0.0000.001 (r = 0.638P 0.0000.001). The Pearson correlation coefficient between);? CSFL concentration and GOS score was (r = -0.794P = 0.0000.001) (bilateral);). The Pearson correlation coefficient between the CSFL concentration and the GCS score was 0.0000.001 (r = 0.752P0. 0000. 001) (the Pearson correlation coefficient between the bilateral); 4CSFL concentration and the Hunt-Hess grade was 0. 0000. 001 (r = 0. 694 0. 001) (bilateral);). 5 the CSFL concentration in the non-complication group (2.09 卤0.47), the CSFL concentration in the complication group (3.52 卤1.17) mmol/L, was significantly different between the two groups (t test 0.0000.001). (6) the change of blood lactate concentration was related to the concentration of CSFL, but the concentration of blood lactate was in the normal range. 7 when the concentration of CSFL was 3.0mmol/L, the complications increased significantly and the prognosis became worse. Conclusion: 1 the concentration of CSFL is significantly correlated with the amount of subarachnoid hemorrhage, GOS,Hunt-Hess grade, GCS score and complication after rupture of aneurysm. The higher the FISHER grade, the higher the Hunt-Hess grade and the higher the CSFL concentration. The worse the prognosis is, the CSFL concentration can be used as a reference index for early evaluation of prognosis after intracranial aneurysm surgery. 2the prognosis of patients with slight increase of CSFL concentration (鈮，

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