动脉瘤性蛛网膜下腔出血延迟性缺血性神经功能障碍发生的相关因素分析

目的 探讨动脉瘤性蛛网膜下腔出血后，继发延迟性缺血性神经功能障碍发生的确切危险因素。方法 回顾性分析118例动脉瘤性蛛网膜下腔出血患者的血流动力学、凝血状态及影像学资料，对延迟性缺血性神经功能障碍发生的相关因素进行多元Logistic回归分析。结果 蛛网膜下腔出血后延迟性缺血性神经功能障碍发生的危险因素有：脑血管痉挛(OR 4．028，95％CI 1．532～10．591)、脑积水(OR 18．564，95％CI 1．518～22．698)、血浆渗透压升高(OR 1．072，95％CI 1．003～1．145)和高血糖(OR 1．064，95％CI 1．009～1．085)。延迟性缺血性神经功能障碍发生的保护因素有：平均动脉压升高(OR 0．917，95％CI 0．086～0．977)。而性别、年龄、Hunt—Hess分级和凝血状态参数与延迟性缺血性神经功能障碍无相关性。结论 蛛网膜下腔出血患者的脑血管痉挛程度加重、合并脑积水、血浆渗透压增高及入院时明显高糖血症，均能高度预示延迟性缺血性神经功能障碍的发生；而适当增加平均动脉压，可以减少延迟性缺血性神经功能障碍发生的风险。

Multivariate analysis of predictors of delayed ischemic neurological deficit after aneurysmal subarachnoid hemorrhage

Objective To investigate the risk factors associated with the occurrence of delayed ischemic neurological deficit (DIND) after aneurysmal subarachnoid hemorrhage (SAH) by use of clinical analysis. Methods The medical records, radiographic files, data of hemodynamics and haemostatic appearance of 118 patients with aneurysmal subarachnoid hemorrhage were studied retrospectively. With these data, a multivariate logistic regression procedure was used to identify the risk factors of DIND. Results The logistic regression demonstrated that cerebral vasospasm (OR 4.028, 95% CI 1.532 - 10.591), hydro cephalus (OR 18.564, 95% CI 1.518 - 226.986), elevated plasma osmotic pressure (OR 1.072, 95% CI 1.003 - 1.145) and hyperglycemia (OR 1.064, 95% CI 1.009 - 1.085) were significantly contributed to occurrence of DIND after SAH, while the mean arterial pressure (OR 0.917, 95% CI 0.086 to 0.977) wasaprotectivefactortoreducedtheoccurrence of DIND. While sex, age, Hunt-Hess classification and haemo static parameter were not related to the occurrence of DIND. Conclusion The occurrence of DIND is associated with severe degree of cerebral vasospasm, incorporation of hydrocephalus, increasing of plasma osmotic pressure and hyperglycemia on admission in SAH patients. The elevation of mean arterial pressure can reduce the risk of the occurrence of DIND.