动脉瘤性SAH迟发性脑血管痉挛的多元因素分析

目的 探讨动脉瘤性蛛网膜下腔出血（SAH）继发脑血管痉挛的相关因素。方法 回顾性分析本院收治的54例动脉瘤性SAH病人的临床资料，判定脑血管痉挛程度，统计分析其相关因素。结果Fisher分级Ⅲ-Ⅳ级患者脑血管痉挛发生率（7014％，19／27）明显高于Fisher分级Ⅰ-Ⅱ级者（4414％，12／27）（P〈0．01）；Hunt—Hess分级Ⅲ-Ⅴ级患者脑血管痉挛发生率（75．0％，21／28）明显高于Hunt—Hess分级Ⅰ-Ⅱ级者（38．5％，10／26）（P〈0．05）；3d后手术患者的脑血管痉挛发生率（70．0％，21／30）明显高于3d内手术患者（41．7％，10／24）（P〈0．05）。结论SAH的Fisher分级〉Ⅱ级和Hunt—Hess分级〉Ⅱ级是颅内动脉瘤继发脑血管痉挛的危险因素。早期手术能降低脑血管痉挛的发生率。

Analysis of Risk Factor of Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

Objective To explore the risk factors of cerebral vasospasm following aneurysmal subarachnoid hemorrhage （aSAH）. Methods The clinical and imaging, data of 54 patients with SAH were analysed retrospectively. The degree of cerebral vasospasm was determined by DSA. The risk factors related to cerebral vasospasm were analysed. Results The incidence （70.4%, 19/27） of cerebral vasospasm in the patients with Fisher scales Ⅲ-Ⅳ aSAH was significantly higher than that （44.4%, 12/27） in the Fisher scales Ⅰ -ⅡaSAH （P〈0.01）. The incidence of the vasospasm （75.0%, 21/28） in the patients with Hunt-Hess scales Ⅲ-Ⅴ was significantly higher than that （38.5%, 10/26） in the patients with Hunt-Hess scales Ⅰ - Ⅱ （P〈0.05）. The incidence （70.0%, 21/30） of the vasospasm in the patients undergoing the operation beyond three days after aSAH was significantly higher than that （41.7%, 10/24） in the patients undergoing the operation within three days after aSAH （P〈0.05）. Conclusions Fisher scale 〉 Ⅱ aSAH and Hunt-Hess scales 〉 Ⅱ disease conditions after aSAH are the independent risk factors of cerebral vasospasm after aSAH. Early operative treatment can decrease the incidence of cerebral vasospasm in the patients with aSAH.