重症动脉瘤性蛛网膜下腔出血预后相关因素的分析

Analysis of the prognosis-related factors of severe aneurysmal subarachnoid hemorrhage

目的探讨重症动脉瘤性蛛网膜下腔出血后相关因素对其预后的影响。方法回顾性分析2005年8月—2010年1月所收治的53例Hunt-HessⅣ、Ⅴ级动脉瘤性蛛网膜下腔出血患者的临床资料,出院时以修订Rankin残疾量表分级为终点指标,评估既往高血压病史、责任动脉瘤的部位及大小、Claassen分级、治疗方式、手术时机、后续手术处理颅高压等因素对预后的影响。结果①有高血压病史21例、Claassen分级Ⅰ～Ⅲ级31例,Ⅳ级22例,后续手术处理颅高压17例。②预后良好25例(25/53),预后不良28例(28/53)。③Logistic多因素回归分析显示,性别、年龄、动脉瘤的部位及大小、手术时机、治疗方式等因素对出院Rankin残疾量表分级的影响,差异无统计学意义(P>0.05)。有高血压病史者Rankin分级的相对危险度(OR)是无高血压病史者的5.333倍(95% CI:1.554～18.304),ClaassenⅣ级是Ⅰ～Ⅲ级的4.191倍(95% CI:1.368～12.838),需后续手术处理颅高压者是无需手术处理的13.269倍(95% CI:2.614～67.360)。结论动脉瘤性蛛网膜下腔出血的预后可受高血压病史、Claassen分级、动脉瘤术后后续手术处理颅内高压等多项因素影响。

Objective To investigate the effect of the related factors on the prognosis of patients after severe aneurysmal subaraehnoid hemorrhage （ aSAH ）. Methods The clinical data of 53 patients with aSAH （ Hunt-Hess grade IV and V ） admitted from August 2005 to January 2010 were analyzed retrospectively. Using the Rankin scale （mRS） grade as the outcome index at discharge to evaluate the effects of the history of hypertension, location and size of responsible aneurysm, Claassen grading, treatment modality, timing of operation, and follow-up surgical treatment of intracranial hypertension on the prognosis of patients. Results （1）Twenty-one patients had history of hypertension, 31 with Claassen grade I to III and 22 with grade IV, and 17 patients had follow-up surgical treatment of intraeranial hypertension; （2）25 patients （25/53） had good prognosis and 28 （28/53） had poor prognosis. （3）Muhivariate Logistic regression analysis showed that the effects of the factors such as gender, age, location and size of responsible aneurysm, timing of operation, and treatment modality on mRS grade at discharge were no significant differences （P 〉0. 05）. The relative risk （RR） of the Rankin grade in patients with history of hypertension was 5. 333 times in those without a history of hypertension （95% CI： 1. 554 to 18. 304）. Claassen grade IV was 4. 191 times of Claassen grade I- Ⅲ （95% CI： 1.368 to 12. 838）. The patients who needed follow-up surgical treatment of intracranial hypertension were 13. 269 times to those did not need surgery （95% CI： 2. 614 to 67. 360）. Conclusion The prognosis of aSAH may be affected by the several factors such as history of hypertension, Claassen grade, and follow-up surgical treatment of intracranial hypertension after aneurysm surgery.