174例蛛网膜下腔出血患者生存率及死亡的相关危险因素历史性队列研究

A historic cohort study on the survival rate and the correlated risk factors regarding 174 patients with subarachnoid hemorrhage

目的描述蛛网膜下腔出血（SAH）患者生存状况，探讨死亡的相关危险因素。方法对174例患者的年龄、既往史、出血累及脑区、实验室检查指标、治疗方式、并发症与预后等进行随访调查，通过Kaplan—Meier生存分析和Cox比例风险模型分析，明确患者生存状况及死亡的相关危险因素。结果共164例患者完成随访调查[失访10例（5．75％）]，其中死亡66例，最长随访时间为5．64年；患者28天生存率70．60％，1年生存率63．40％，3-5年生存率57．20％；应用尼膜同、行动脉瘤夹闭和栓塞治疗可以显著降低患者的死亡风险；而高龄、长期吸烟、低钠血症、急性期白细胞增高、再出血和脑血管痉挛等将显著增加患者的死亡风险。结论高龄、急性期白细胞增高、并发低钠血症、消化道出血、再出血和脑血管痉挛的SAH患者预后不良；给予尼膜同、行动脉瘤夹闭或栓塞治疗可以降低动脉瘤性SAH患者的死亡风险。

Objective To describe the survival state and to investigate the risk factors of death on patients with subarachnoid hemorrhage （SAH）. Methods Age, past history, number of encephalic region suffering SAH, laboratory examination indexes, therapeutic measures, complications and prognosis of 174 patients with SAH were followed-up and investigated. The survival states and risk factors of death of the patients with SAH were identified by both Kaplan-Meier survival analysis and Cox proportional risk model. Results There were 10 patients （5.75%） losing follow-up investigation and 164 patients with SAH completed the follow-up investigation. 66 patients died and the longest follow-up investigation time was 5.64 years. The survival rates of 28 days, 1 year and 3-5 years were 70.60%, 63.40% and 57.20% respectively. The treatment of nimotop, aneurysm occlusion treatment and aneurysm embolotherapy could decrease the death of SAH. At the same time, advanced age, the long time smoking, hyponatremia, the rising of leucocyte in acute stage, repeated hemorrhage and cerebral angio spasm were the independent risk factors to the death of patients. Conclusion Prognosis of patients with advanced age, the rising of leucocyte in acute stage, gastrointestinal blooding, hyponatremia, repeated hemorrhage and cerebral angio spasm were unfavorable. When giving patients with aneurysm, the aneurysm occlusion and embolotherapy and nimotop treatment, the death risk could be reduced.