高分级动脉瘤性SAH 患者术后1 年内预后不良因素研究

目的 探讨高分级动脉瘤性SAH 患者术后1 年内预后不良的影响因素。方法 选取早期手术治疗的168 例高分级动脉瘤性蛛网膜下腔出血（SAH）患者作为研究对象。其中，世界神经外科联盟（WFNS）Ⅳ级78 例，Ⅴ级90 例。若患者术后1 年的格拉斯哥预后量表（GOS）评分为1 ～ 3 分，即视为预后不良。统计所有患者的性别、年龄等基线资料；动脉瘤的最大径、位置、数目、有无脑实质出血、脑室出血铸型、脑疝及WFNS 分级等术前资料；手术方式、手术距离出血的时间、术后有无脑血管痉挛（CVS）、再出血、切口感染及肺炎等并发症。采用多因素Logistic 回归分析探讨影响患者预后不良的独立因素。结果 168 例患者术后1年的随访结果为预后不良95 例（56.5%），包括死亡66 例（39.3%）。合并高血压史、糖尿病史的患者术后1 年预后不良发生率高于未合并患者，差异有统计学意义（P <0.05）；前循环、多发动脉瘤、有脑实质出血、脑室出血铸型、脑疝及WFNS 分级为Ⅴ级患者术后1 年预后不良发生率升高，差异有统计学意义（P <0.05）；术后CVS、再出血患者术后1 年预后不良发生率高于未合并者，差异有统计学意义（P <0.05）。多因素Logistic 回归分析结果表明，高血压史、责任动脉瘤的位置为前循环、脑室出血铸型及术后CVS 是患者术后1 年预后不良的独立危险因素（P <0.05）。结论 >50% 的高分级动脉瘤性SAH 患者术后出现预后不良，高血压史、责任动脉瘤的位置为前循环、脑室出血铸型、术后CVS 是患者术后1 年预后不良的独立危险因素。

Related factors of poor prognosisin one year after surgery for patients with high-grade aneurysmal subarachnoid hemorrhage

Objective To investigate the related factors ofpoor prognosis in one year after surgery for patientswith high-grade aneurysmal subarachnoid hemorrhage (SAH). Methods A total of 168 patients with high-gradeaneurysmal SAH had undergone early surgery from January 2011 to December 2016 were enrolled for the study,including 78 cases with World Federation of Neurosurgical Societies (WFNS) grade IV and 90 cases withgrade V.Patients with the Glasgow Outcome Scale (GOS) score of 1-3 points at 1 year after surgery were classified as thepoor prognosis. Baseline data including gender, age and so on. Preoperative data including maximum size, location,numberof aneurysm, intraparenchymal hemorrhage, cerebroventricular hemorrhage, cerebral hernia and WFNS grade,surgical method, operative time, interval time between bleeding and surgery, postoperative complication sincluding cerebrovascular spasm (CVS), rebleeding, wound infection and pneumonia were analyzed statistically. Multivariate logistic regression analysis was used to investigate the independent factors affecting the prognosis of patients. Results A total of 95 patients (56.5%) had poor prognosis in one year after surgery, including 66 patients (39.3%) dead. The incidences of poor prognosis in patients with history of hypertension and diabetes mellitus were significantly higher than that of the patients without them (P < 0.05). The incidences of poor prognosis inpatients withanterior circulation aneurysm, multiple aneurysms, intraparenchymal hemorrhage, cerebroventricular hemorrhage, cerebral hernia, WFNS grade V increased significantly (P < 0.05). The incidences of poor prognosis in patients with postoperative CVS and rebleeding were significantly higher than that of patients without these complications (P < 0.05). Multivariate logistic regression analysis showed that the history of hypertension, anterior circulation aneurysm, cerebroventricular hemorrhage and postoperative CVS were the independent risk factors of poor prognosis (P < 0.05). Conclusions More than 50% patients with high-grade aneurysmal SAH have poor prognosis after surgery. History of hypertension, anterior circulation aneurysm, cerebroventricular hemorrhageand postoperative CVS ware the independent risk factors of poor prognosis.