动脉瘤性蛛网膜下腔出血后脑血管痉挛的危险因素分析

A analysis of risk factors in anneurysmal cerebral vasospasm after subarachnoid hemorrhage

目的探讨动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,a SAH)后脑血管痉挛(cerebral vasospasm,CVS)相关危险因素,为其临床预防及治疗提供依据。方法回顾性分析2012年3月至2014年3月收治的255例a SAH患者临床资料,主要包括分析年龄、性别、民族、高血压病史、吸烟史、动脉瘤的部位、改良Fisher分级、入院时Hunt-Hess分级、小剂量尼莫同、脱水剂、白细胞计数、血糖、血脂、血钙水平、血小板计数等,并对上述因素与CVS的发生进行单因素分析和多因素Logistic回归分析。结果 255例a SAH患者中,共出现CVS患者73例,a SAH后CVS的发生率为28.6%;单因素分析提示,高血压史、吸烟史、改良Fisher分级、入院时Hunt-Hess分级、小剂量尼莫同、白细胞计数及血糖差异有统计学意义(P﹤0.05)。Logistic回归分析提示,高血压病史、吸烟史、改良Fisher分级、入院时Hunt-Hess分级、小剂量尼莫同及白细胞计数是a SAH后CVS的危险因素(P﹤0.05)。结论高血压病史、吸烟史、改良Fisher分级高、入院时Hunt-Hess分级高是a SAH后CVS的独立危险因素,小剂量尼莫同是其保护因素,白细胞计数是预测因子,故临床应加强危险因素的控制。

Objective To investigate the risk factors of aneurysmal subarachnoid hemorrhage （aneuryismal sub？arachnoid hemorrhage, aSAH） vasospasm （cerebral vasospasm, CVS） and provide the basis for the clinical prevention and treatment of CVS. Methods A retrospective analysis of clinical data was conducted on 255 cases aSAH patients receiving treatment between March 2012 and March 2014 in First Affiliated Hospital of Xinjiang Medical University Department of Neurosurgery, s treated. The clinical data included admission age, gender, ethnicity, history of hypertension, smoking his？tory, arterial tumor site, improved Fisher grading, admission Hunt-Hess grade, the dosage of Nimodipine, dehydrating agent, white blood cell count, blood glucose, blood lipids, blood calcium levels, platelet count. Univariate analysis and multivariate Logistic retrospective analysis were used to analyze the association between above-mentioned factors and the occurrence of CVS. Results A total of 73 cases developed CVS after aSAH and incidence rate of CVS was 28.6%. Uni？variate analysis showed that there were significant differences between patients with and without CVS in history of hyper？ tension, smoking history, improved Fisher grade, admission Hunt-Hess grade, small doses of nimodipine, white blood cell count and blood glucose （P〈0.05）. The Logistic regression analysis showed that the history of hypertension, smoking history, improved Fisher grade, admission Hunt-Hess grade, a small dose of Nimodipine and white blood cell count were risk factors of CVS after aSAH （P〈0.05）. Conclusions the History of hypertension, smoking history, improved high Fish？er grade, high admission Hunt-Hess grade are independent risk factors of CVS after aSAH. A small dose of Nimodipine is a protective factor while increase in white blood cell count is a risk predictor, which should be controlled by enhancing clinical prevention.