脑池及脑池积血在动脉瘤性蛛网膜下腔出血后急性脑积水发生中的作用

Roles of cistern and cisternal hemorrhage in the occurrence of acute hydrocephalus after aneurysmal subarachnoid hemorrhage

目的探讨脑池及脑池积血在动脉瘤性蛛网膜下腔出血（aSAH）后急性脑积水发生中的作用。方法对南方医科大学南方医院神经外科2011年5月至2014年1月经手术治疗且资料完整的306例aSAH患者的临床数据进行回顾性分析，其临床变量进行单因素分析和多因素Logistic回归分析，并对各个脑池的血量进行定量分析。结果306例患者中有112例发生了急性脑积水，发生率为36．6％。单因素分析表明Fisher分级、脑室积血、动脉瘤的位置、动脉瘤侧别、再出血、治疗方式6项因素比较差异有统计学意义（P〈0．05）；多因素Logistic回归分析显示动脉瘤位置与脑室积血为其独立发生因素。在无脑室积血的患者中，急性脑积水的发生率为22．4％，其中脑积水组中的脚间池、右侧侧裂池血量最多，与非脑积水组相比差异有统计学意义（P=0．000；P=0．005）。结论aSAH急性脑积水是多因素共同作用的结果，动脉瘤位置与脑室积血是其独立危险因素；aSAH急性脑积水是梗阻性脑积水，脑池的位置及脑池积血的分布在aSAH急性脑积水发生中有着重要的影响作用；在无脑室积血的aSAH患者中，脚间池、右侧侧裂池的积血血量越大，越容易发生急性脑积水。

Objective To investigate the roles of cistern and cisternal hemorrhage in the occurrence of acute hydrocephalus after aneurysmal subarachnoid hemorrhage （aSAH）. Methods The clinical data of 306 patients with aSAH diagnosed and treated surgically at the Department of Neurosurgery, Nanfang Hospital, Southern Medical University from May 2011 to January 2014 were analyzed retrospectively. Their clinical variables were analyzed with the univariate analysis and multivariate logistic regression analysis, and the blood volume of each cistern was analyzed quantitatively. Results Among of the 306 patients, 112 had acute hydrocephalus, and the incidence was 36. 6%. Univariate analysis suggested that there were significant differences in six factors, including Fisher grade, intraventricular hemorrhage, location of aneurysm, sides of aneurysm, rebleeding, and treatment （ P 〈 0. 05 ） ; multivariate logistic regression analysis showed that the location of aneurysm and intraventricular hemorrhage were its independent occurrence factors. In patients without intraventricular hemorrhage, the incidence of acute hydrocephalus was 22.4%, of which the blood volumes of interpeduncular cistern and right sylvian cistern were the maximum in the hydrocephalus group. Compared with the non-hydrocephalus group, there were significant differences （P = 0. 000 ; P = 0. 005）. Conclusions Acute hydrocephalus after aSAH is the result of multiple factors working together. The location of aneurysm and intraventricular hemorrhage are its independent risk factors. The acute hydrocephalus after aSAH is an obstructive hydrocephalus. The location of cistern and the distribution of cisternal hemorrhage have important influences in the occurrence of acute hydrocephalus after aSAH. In aSAH patients without intraventricular hemorrhage, the larger the hematocele volume of the interpeduncular cistern and right sylvian cistern, the more prone to acute hydrocephalus