蛛网膜下腔出血后无迟发性脑缺血相关因素分析

Factors associated with no delayed cerebral ischemia after subarachnoid hemorrhage

目的分析动脉瘤性蛛网膜下腔出血（aSAH）后无迟发性脑缺血（DCI）的相关因素,以期为DCI病人转出重症监护病房（ICU）提供临床依据。方法选取2001-10—2011-06确诊的动脉瘤性蛛网膜下腔出血且入住重症监护病房患者153例,其中DCI组67例,非DCI组86例;分析蛛网膜下腔出血后无迟发性脑缺血的相关因素。结果 DCI组一般情况相比非DCI组显示：平均年龄、入院血糖〉6.1mmol/L、后循环动脉瘤、脑室出血差异有统计学意义（P〈0.05）;服用他汀类药物、GCS评分、WFNSⅠ-Ⅲ级、改良Fisher分级Ⅰ-Ⅱ级、TCD血管痉挛、血管造影血管痉挛差异有统计学意义（P〈0.001）;单因素分析显示：年龄〉65岁,WFNS分级Ⅰ-Ⅲ级、改良Fisher分级1-2级、无颅内血肿和后交通动脉瘤与动脉瘤性蛛网膜下腔出血后无迟发性脑缺血相关（P〈0.05）;多因素分析发现年龄〉65岁,WFNSⅠ-Ⅲ级,改良Fisher分级1-2级是未发生DCI的独立因素。结论年龄〉65岁,WFNSⅠ-Ⅲ级和改良Fisher分级1-2级可作为病人转出ICU病房的依据。

Objective To explore factors associated with no delayed cerebral ischemia in patients with aneurismal subarachnoid hemorrhage,and to provide clinical evidence for patients with DCI transfering from the intensive care unit（ICU）to ordinary ward treatment.Methods 153 patients with aneurismal subarachnoid hemorrhage treated in ICU from October 2001 to June 2011 were involved in the analysis.67 of them developed DCI while 86 of them not.The factors associated with no delayed cerebral ischemia after subarachnoid hemorrhage were analyzod.Results Factors below were statistically significant（P〈0.05）：average age（〉65 years old）,admission glucose level（〉6.1mmol/L）,posterior circulation aneurysm,intraventricular hemorrhage,.Factors below were significant statistically significant（P〈0.01）：taking statins,GCS score,WFNS Ⅰto Ⅲ,modified Fisher grade 1 to 2,asospasm in TCD and angiography.Univariate analysis showed that these factors were related with no delayed cerebral ischemia after subarachnoid hemorrhage（P〈0.05）：average age（〉65 years old）,WFNSⅠtoⅢ,modified Fisher grade 1 to 2,no intracranial hematoma and posterior circulation aneurysm,multiple-factor analysis showed that these factors were independent factors of the absence of delayed cerebral ischemia：average age（〉65 years old）,WFNS Ⅰto Ⅲ,modified Fisher grade 1 to 2.Conclusion These factors a independent factors of the absence of delayed cerebral ischemia：average age（〉65 years old）,WFNS Ⅰto Ⅲ,modified Fisher grade 1 to 2,and provide clinical evidence for patients with DCI transfering from the intensive care unit（ICU）to ordinary ward treatment.