动脉瘤性蛛网膜下腔出血患者生存率及死亡相关危险因素的历史性队列研究

目的描述动脉瘤性蛛网膜下腔出血（aSAH）患者生存状况，探讨患者死亡相关危险因素。方法对88例aSAH患者年龄、性别、既往病史、治疗措施、并发症与预后等进行随访调查，通过Kaplan-Meier生存分析和COX比例风险模型分析，明确患者生存状况及死亡相关危险因素。结果88例全部完成随访，总随访时间141．9人年，平均随访时间（1．6±1．0）人年，最长随访时间5．6年；患者1个月、1年和2．5～5．6年累积生存率依次为78％、73％和68％；应用尼莫地平（RR=0．981，95％CI=0．965～0．997，P=0．023）可降低aSAH患者死亡风险；以内科保守治疗为参照，手术夹闭（RR=0．147，95％CI=0．041～0．532，P=0．003）和介入栓塞（RR=0．221，95％CI=0．060-，0．823，P=0．024）治疗为保护性因素，而并发症（低钠血症、肺部感染、消化道出血，PaY=1．965，95％CI=1．404—2．748，P〈0．05）和脑血管痉挛（RR=2．951，95％CI=1．473～5．911，P=0．002）为患者死亡独立危险因素。结论并发低钠血症、肺部感染、消化道出血和脑血管痉挛是aSAH患者预后不良的危险因素；尼莫地平、手术夹闭或介入栓塞治疗，可降低aSAH患者死亡风险。

Survival of patients with aneurysm subarachnoid hemorrhage and its related factors

Objective To describe survival of patients with aneurysm subarachnoid hemorrhage （aSAH） and its related factors. Methods Data of 88 patients with aSAH were analyzed retrospectively, including their age, gender, past medical history, therapeutic measures, complications and prognosis, and so on. Their survival and its related factors were identified by Kaplan-Meier method and COX proportional hazard regression model. Results Eighty-eight patients were followed-up for a total of 141.9 person-year, with an average of （ 1.6±1.0） years, and the longest of 5.6 years. Survival was 78 percent, 73 percent and 68 percent in the first month, first year and 2. 5-5.6 years after onset, respectively. Administration of nimodipine （RR = 0. 981, 95% CI = 0. 965 -0. 997, P = 0. 023 ） was potential protective factor for deaths caused by aSAH. Compared with conservative medical treatment, both surgical occlusion （RR = 0. 147, 95% CI = 0. 041 - 0. 532, P = 0. 003 ） and intervention embolotherapy （ RR = 0. 221, 95% CI = 0. 060 - 0. 823, P =0.024） were also protective factors. However, complications such as hyponatremia, pulmonary infection, alimentary tract hemorrhage （RR = 1. 965, 95% CI = 1. 404 - 2. 748, P 〈 0. 05 ） and cerebral vasospasm （RR =2. 951, 95% CI = 1. 473 -5. 911 , P =0. 002） were independent risk factors for aSAH. Conclusions Prognosis in patients with hyponatremia, pulmonary infection, alimentary tract hemorrhage and cerebral vasospasm is unfavorable, and aneurysm occlusion by surgical operation, embolotberapy and administration of nimodipine all can decrease fatality caused by aSAH.