181例高分级动脉瘤性蛛网膜下腔出血患者术前再出血的影响因素

Factors of preoperative rebleeding in 181 patients with poor-grade aneurysmal subarachnoid hemorrhage

目的探讨高分级动脉瘤性蛛网膜下腔出血(aSAH)患者术前再出血的影响因素。方法本研究为回顾性队列研究,共纳入181例符合世界神经外科学会联合会(WFNS)IV级和V级的aSAH患者。所有患者根据在治疗前有无再出血分为再出血组(n=26)和未再出血组(n=155)。采用病例-对照研究分析方法,分析比较两组患者的人口统计学特征、病史、临床状况、WFNS分级、CT Fisher分级、动脉瘤特征、治疗时间及6个月时的预后有关联的影响因素。结果181例中有26例术前再出血。再出血组和未再出血组的性别、年龄、既往史(高血压、糖尿病、肥胖)、个人史(吸烟、酗酒)、临床状况(脑疝、脑内血肿、低密度区、脑积水)和放射学特征(动脉瘤位置、动脉瘤大小、多发动脉瘤)的差异均无统计学意义。再出血组中脑室内出血(IVH)13例,WFNS分级V级15例,CT Fisher分级3~4级25例,与未再出血组相比差异均有统计学意义。多因素分析表明,脑室内出血(OR=3.804,95%CI:1.161~12.462,P=0.027)为再出血的独立危险因素。再出血组预后不良(mRS 3~6分)20例(76.92%),死亡率26.9%,与未再出血组相比差异有统计学意义,再出血组的预后不良。结论IVH、WFNS V级和CT Fisher 3~4级与术前再出血相关。人口统计学特征、病史、临床状况、患者治疗时间、脑室外引流和动脉瘤特征与术前再出血无显著相关性。

Objective To investigate the influencing factors of rebleeding in patients with poor-grade aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 181 patients who met the World Federation of Neurosurgical Societies(WFNS)grade IV or V criteria were enrolled in this retrospective cohort study.The patients were divided into rebleeding group(n=26)and non-rebleeding group(n=155).Case-control study analysis was used to compare the demographic characteristics,medical history,clinical status,WFNS grade,CT Fisher grade,aneurysm characteristics,treatment timing and outcomes at 6 months between the two groups.Results Preoperative relleeding was observed in 26 of 181 cases.There were no significant statistical differences between the two groups in gender,age,medical history(hypertension,diabetes and obesity),personal history(smoking and drinking),clinical status(cerebral hernia,intracerebral hematoma,low density area and hydrocephalus)and radiological characteristics(aneurysm location,aneurysm size,multiple aneurysms).In the rebleeding group,13 cases had intraventricular hemorrhage,15 cases were of WFNS grade V,25 cases were of CT Fisher grade 3-4,and the differences were statistically significant compared with those in the non-rebleeding group.Multivariate analysis showed that intraventricular hemorrhage(OR=3.804,95%CI:1.161-12.462,P=0.027)was an independent risk factor for rebleeding.In the rebleeding group,20 cases(76.92%)had poor prognosis(mRS 3-6),and the mortality rate was 26.9%.The difference was statistically significant compared with that in the non-rebleeding group.Unfavorable outcomes occurred more often in the rebleeding group.Conclusion IVH,WFNS grade V and CT Fisher grade 3-4 are associated with rebleeding.Demographic characteristics,medical history,clinical status,treatment timing,external ventricular drainage(EVD)or aneurysm characteristics are not significantly associated with rebleeding.