影响外伤性蛛网膜下腔出血病人预后的因素分析

Analysis of prognostic factors in patients with traumatic subarachnoid hemorrhage

目的 探讨可影响外伤性蛛网膜下腔出血（tSAH）病人治疗结果的因素及其CT变化的特点。方法 回顾性分析了一组连续收治的入院时经头颅CT检查确诊为tSAH的闭合性颅脑损伤病人资料，记录其入院时和病情加重时的头颅CT情况、入院时GCS评分、以Fisher分级法对出血量进行分级情况、伤后6个月以GOS评分法评估的治疗结果，并对数据加以统计分析。结果 多因素Logisitc回归分析显示，初次CT扫描tSAH出血量Fisher分级（OR=50．7，P〈0．001）、入院时GCS评分（OR=2．86，P〈0．001）、初次CT扫描基底池tSAH（OR=0．35，P=0．030）与tSAH患者的不良结果存在显著相关。最初CT显示脑挫裂伤与入院后CT出现恶化（OR=2．92，P=-0．003）及入院后CT示显著恶化（OR=3．21，P〈0．001）有显著相关性。结论 tSAH病人的治疗结果与入院时GCS评分、出血量及脑挫裂伤的存在或范围有关，这些也是头颅CT出现显著恶化的相关因素，说明头颅CT显示出的恶化与治疗结果是有其内在联系。

Objective To investigate the factors associated with prognosis and changes of CT scans in patients with traumatic subarachnoid hemorrhage （tSAH）. Methods We collected the data of 267 patients who were admitted consecutively into our department with a CT diagnosis of tSAH, and recorded the CT scans, the Glasgow Coma Scale （GCS） scores on admission. We also used Fisher classification to record the amount of subarachnoid blood of the patients, and assessed the outcome of the patients with the Glasgow Outcome Scale （GOS） at the 6th month after injury. Results Logisitc regression displays that the bad outcome was related to Fisher degree of amount of subarachnoid blood on initial CT scan（OR=50.7, P〈0.001）, GCS score on admission（OR=2.86, P〈0.001）, tSAH in basal cisterns on initial CT scan（OR=0.35 ,P=0.030）. Obvious correlations are displayed between initial brain contusions by CT scan, and, the occurrence of deterioration by CT scan after admission （OR=2.92 ,P= 0.003） and the evident deterioration by CT scan after admission （OR=3.21 ,P〈0.001）. Conclusion The outcome of tSAH patients is associated with GCS scores on admission, amount of subarachnoid blood and presence or size of brain contusions. These factors can also predict the changes of CT scans. Therefore, the unfavorable outcome is associated with the worst lesion progression on CT scans.