动脉瘤性蛛网膜下腔出血后症状性血管痉挛186例

Symptomatic vasospasm after subarachnoid hemorrhage:study of 186 cases

目的探讨动脉瘤性蛛网膜下腔出血（SAH）后影响症状性血管痉挛发生的危险因素.方法回顾性分析186例经影像学和腰椎穿刺证实的动脉瘤性蛛网膜下腔出血患者的临床表现和影像学检查.结果 186例中55例（29.6 %）发生症状性血管痉挛;FisherⅢ级,临床状况不良,反复SAH发作患者的症状性血管痉挛发生率显著升高（P〈0.01）;性别、不同年龄组患者、不同动脉瘤治疗方式组（手术夹闭或栓塞）患者症状性血管痉挛发生率无统计学意义（P〉0.05）;入院后是否使用抗纤溶药物（AFD）治疗对症状性血管痉挛发生率无明显影响（P〉0.05）.多因素分析显示FisherⅢ级[OR=2.549,95%可信区间（CI）1.406～4.517]、临床状况不良（OR=2.342,95% CI 1.320～4.159）和反复SAH发作（OR=2.492,95% CI 1.394～4.448 ）是影响症状性血管痉挛发生的危险因素.结论 FisherⅢ级、临床状况不良和反复SAH发作是症状性血管痉挛的独立危险因素.可根据蛛网膜下腔积血量、入院时临床状况和SAH发作次数预测症状性血管痉挛的发生.

Objective To identify the risk factors associated with symptomatic vasospasm after aneurysmal subarachnoid hemorrhage （SAH）. Methods The clinical data of 186 cases with SAH verified by radiology and lumbar puncture were reviewed retrospectively. Results Fifty-five of the 186 patients （29.6%） developed symptomatic vasospasm. The incidence of symptomatic vasospasm was significantly higher in the patients of Fisher grade Ⅲ than in those of Fisher grade I and Fisher grade Ⅱ , in the patients in poor clinical status at admission the in those in better clinical status, and in the patients with repeated of SAH then in those without reoccurrence （all P 〈 0.01 ）. Sex, age, treatment medality, and use of antifibrinolytic drugs （AFD） did not influence the development of symptomatic vasospasm （all P 〉0. 05）. Multivariate analysis showed that Fisher grade Ⅲ [ odds ratio （OR） 2. 549,95% confidence interval （CI） 1.406-4.517], poor clinical status at admission （ OR 2. 342,95% CI 1. 320-4. 159 ） and repeated of SAH （ OR 2. 492,95% CI 1. 394 - 4. 448 ） were associated with the increased risk of symptomatic vasospasm. Conclusion Fisher grade m, poor clinical status at admission and repeated reoccurrence of SAH are significant independent risk factors of symptomatic vasospasm. The presence of symptomatic vasospasm can be independently predicted by the amount of subarachnoid hemorrhage, clinical status at admission, and times of SAH.