动脉瘤性蛛网膜下腔出血后迟发性脑缺血的危险因素分析

目的探讨动脉瘤性蛛网膜下腔出血(a SAH)患者发生迟发性脑缺血(DCI)的危险因素。方法回顾性连续纳入2015年1月至2016年4月南京军区南京总医院神经外科收治的接受血管内介入治疗的a SAH患者106例,根据是否发生DCI,将患者分为DCI组(34例)与无DCI组(72例)。收集患者一般资料,包括性别、年龄、Hunt-Hess分级、改良Fisher分级、世界神经外科联盟(WFNS)分级、急性脑水肿、早期(出血1~3 d)低白蛋白血症、低血红蛋白血症等。进行单因素和多因素Logistic回归分析DCI发生的危险因素。结果 DCI发生率为32.1%(34/106)。DCI组Hunt-Hess分级≥Ⅲ级、改良Fisher分级≥Ⅲ级、WFNS分级≥Ⅳ级、急性脑水肿、低血红蛋白血症及低白蛋白血症的发生率均高于无DCI组,组间差异均有统计学意义(均P0.05);性别、年龄≥55岁、高血压病、糖尿病、低钠血症比例的组间差异均无统计学意义(均P0.05)。将单因素分析中Hunt-Hess分级≥Ⅲ级、改良Fisher分级≥Ⅲ级、入院WFNS分级≥Ⅳ级、低白蛋白血症作为自变量进行多因素分析,结果显示,入院WFNS分级≥Ⅳ级(OR=8.02,95%CI:2.41~26.70)、改良Fisher分级≥Ⅲ级(OR=4.44,95%CI:1.38~14.32)、1~3 d低白蛋白血症(OR=5.42,95%CI:1.40~20.76)是a SAH患者发生DCI的独立危险因素(均P0.05)。而Hunt-Hess分级≥Ⅲ级不是a SAH患者发生DCI的危险因素(OR=1.86,95%CI:0.39~8.88,P0.05)。结论 a SAH后低白蛋白血症、入院WFNS分级≥Ⅳ级、改良Fisher分级≥Ⅲ级是患者发生DCI的独立危险因素,临床诊治过程中应引起高度重视。

Risk factor analysis of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Objective To investigate the clinical risk factors of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH).Methods From January 2015 to April 2016,106 consecutive patients with aSAH treated with endovascular embolization at the Department of Neurosurgery,Nanjing General Hospital of Nanjing Military Command were enrolled retrospectively.The patients were divided into either a DCI group (n =34) or a non-DCI group (n =72) according to whether the occurrence of DCI.The general information of patients were collected,including sex,age,Hunt-Hess grade,modified Fisher grade,world federation of neurosurgical societies (WFNS) grade,acute cerebral edema,early (bleeding 1-3 d) hypoalbuminemia,and hypohemoglobinemia.Univariate and multivariate Logistic regression analyses were used to analyze the risk factors for occurrence of DCI.Results The incidence of DCI was 32.1％ (34/106).The Hunt-Hess grade ≥ Ⅲ,modified Fisher grade ≥ Ⅲ,WFNS grade ≥ Ⅳ,acute cerebral edema,the incidences of hypoalbuminemia and hypohemoglobinemia in the DCI group were higher than those in the non-DCI group.There were significant differences between the 2 groups (all P ＜ 0.05).There were no significant differences in the ratios of sex,age ≥ 55 years,hypertension,diabetes and hyponatremia between the 2 groups (all P ＞ 0.05).In univariate analysis,the Hunt-Hess grade ≥ Ⅲ grade,modified Fisher grade ≥ Ⅲ,WFNS grade ≥ Ⅳ on admission,and hypoalbuminemia were used as the independent variables for multivariate analysis,the results showed that WFNS grade ≥ Ⅳ (OR,8.02;95 ％ CI 2.41-26.70),modified Fisher grades ≥ Ⅲ (OR,4.44;95％ CI 1.38-14.32),and hypoalbuminemia at day 1-3 (OR,5.42;95％ CI 1.40-20.76) were the independent risk factors for occurring DCI in patients with aSAH (all P ＜ 0.05),and the Hunt-Hess grade ≥ Ⅲ was not the risk factor for occurring DCI in patients with aSAH (OR,1.86;95％ CI 0.39-8.88,P ＞ 0.05).Conclusion The patients with hypoalbuminemia,WFNS grade≥Ⅳ on adrnission,and modified Fisher grade ≥ Ⅲ may were the independent risk factors DCI after aSAH,and the clinical diagnosis and treatment should attach great importance to.