蛛网膜下腔出血患者迟发性脑血管痉挛相关因素的临床分析

Risk factors of delayed cerebral vasospasm following subarachnoid hemorrhage： a clinical analysis

目的探讨动脉瘤性蛛网膜下腔出血（SAH）患者迟发性脑血管痉挛（DCVS）的临床影响因素。方法回顾性分析南方医科大学珠江医院神经外科自2005年1月至2008年12月收治的74例动脉瘤性SAH患者的临床资料，判定DCVS，统计分析其影响因素。结果年龄、出血次数、吸烟史、Hunt—Hess分级、Fisher分级、白细胞计数峰值与DCVS的发生具有明显相关性，其中年龄、出血次数、Hunt—Hess分级、Fisher分级是DCVS发生的独立影响因素。结论低年龄、出血2次以上及Hunt—Hess分级或Fisher分级Ⅲ级以上患者更易发生DCVS，临床上对此类患者应加强监测、及早发现和处理。

Objective To identify the risk factors of delayed cerebral vasospasm following aneurysmal subarachnoid hemorrhage （SAH）. Methods The clinical data of 74 patients with SAH were retrospectively analyzed. The severity of delayed cerebral vasospasm in these patients was assessed according to the findings by digital subtraction angiography, and the risk factors for delayed cerebral vasospasm following SAH were analyzed. Results The patients＇age, number of SAH episode, history of smoking, Hunt-Hess grade, Fisher grade and peak white blood cell count were found to significantly correlated to the occurrence of delayed cerebral vasospasm. Among these factors, the patients＇ age, number of SAH, Hunt-Hess grade, and Fisher grade were identified as the independent risk factors of delayed cerebral vasospasm. Conclusions Patients with younger age, SAH more than twice, and Hunt-Hess or Fisher grades over III are at higher risk of delayed cerebral vasospasm. Close monitoring for early detection of delayed cerebral vasospasm and timely management are crucial in these patients.