颅内高分级动脉瘤性蛛网膜下腔出血患者的生存状况分析

Analysis of living conditions of patients with high grade aneurysmal subarachnoid hemorrhage

目的分析颅内高分级动脉瘤性蛛网膜下腔出血患者的生存状况。方法选取2015年4月至2020年5月中国人民解放军联勤保障部队第九八九医院收治的60例动脉瘤性蛛网膜下腔出血患者,根据Hunt-Hess分级为Ⅳ级和Ⅴ级中的34例患者为观察组(其中Ⅳ级患者24例,Ⅴ级患者10例),26例Hunt-Hess分级为Ⅲ级及以下患者作为对照组,进行回顾性分析。通过CT血管造影和数字减影血管造影(DSA)影像技术进行诊断,根据住院患者指标资料对观察组患者和对照组患者症状性脑血管痉挛(CVS)相关指标、脑积水发生情况、破裂动脉瘤再出血情况、格拉斯哥昏迷评分(GCS)各项数据进行筛选调查,调查两组患者出院后不同时间的死亡率。根据调查结果和医院资料对颅内高分级动脉瘤性蛛网膜下腔出血患者的生存状况进行分析。结果观察组患者和对照组患者状性脑血管痉挛指数分别为(7.14±1.22)、(2.15±1.08),观察组表现为脑血管痉挛;观察组患者和对照组患者脑积水发生率分别为73.5%、61.5%,动脉瘤再出血几率分别为67.6%(23例)、42.3%(11例),GCS评分(3.14±1.12)、(4.34±1.07),观察组表现为中到重度昏迷;观察组和对照组出院后1年、2年死亡率分别为20.6%(7例)、32.4%(11例)和11.5%(3例)、15.4%(4例)。中低分级的对照组相同的各项指标均低于观察组,结果差异具有统计学意义(P<0.05)。结论颅内高分级动脉瘤性蛛网膜下腔出血患者生存状况差,残疾率和死亡率高。

Objective To analyze the survival status of intracranial patients with high grade aneurysmal subarachnoid hemorrhage.Methods A total of 60 patients with aneurysmal subarachnoid hemorrhage who received treatment in our hospital from April 2015 to May 2020 were selected.Thirty-four patients classified asⅣand Lit according to Hunt-Hess classification were included in the observation group(24 patients with Grade I and 10 patients with Grade I).Twenty-six patients with Hunt-Hess gradeⅢor below were used as the control group for retrospective analysis.By CT angiography and digital subtraction angiography(DSA)image diagnosis technology,according to the index of hospitalized patients in the observation group of patients and the control group in patients with symptomatic cerebral vasospasm(CVS)related indicators,hydrocephalus,ruptured aneurysm bleeding again,what is happening in Glasgow coma scale(GCS)filtered data survey.The mortality rate of observation group and control group at different time after discharge was investigated.According to the survey results and hospital data,the survival status of intracranial patients with high-grade aneurysmal subarachnoid hemorrhage was analyzed.Results The index of cerebral vasospasm in the observation group and the control group was(7.14±1.22)and(2.15±1.08),respectively.The high grade observation group showed cerebral vasospasm.The incidence of hydrocephalus in observation group and control group was 73.5%and 61.5%,and the incidence of aneurysm rebleeding was 67.6%(23 cases)and 42.3%(11 cases),with GCS score of(3.14±1.12)and(4.34±1.07).The observation group presented as moderate to severe coma.The one-year and two-year mortality rates in the observation group and the control group were 20.6%(7 cases)and 32.4%(11 cases),11.5%(3 cases)and 15.4%(4 cases),respectively.The same indexes in the middle and low grade control group were lower than those in the observation group,and P<0.05 showed difference in results.Conclusion Patients with intracranial high grade aneurysmal subarachnoid hemorrhage have poor survival,high disability rate and high mortality rate.