动脉瘤性蛛网膜下腔出血患者早期手术与临床转归的相关性研究

Correlation of early surgery and clinical outcomes in patients with aneurysmal subarachnoid hemorrhage

目的探讨动脉瘤性蛛网膜下腔出血（a SAH）患者早期手术与临床转归的相关性。方法回顾性纳入该院接受血管介入手术或开颅动脉瘤夹闭术治疗的a SAH住院患者,收集其人口统计学和临床资料。采用改良Rankin量表（mRS）评价患者6个月后的转归。采用单变量及多变量Logistic回归分析确定影响a SAH患者临床转归的危险因素。结果共纳入a SAH患者84例,其中24例接受早期手术,60例接受晚期手术;58例转归良好,26例转归不良。单变量分析显示早期手术组6个月时转归良好率（87.50%vs 61.67%;χ2=5.353,P=0.021）高于晚期手术组。转归良好组与转归不良组相比,入院时收缩压高（t=-3.268;P=0.002）、脑血管痉挛（15.52%vs 57.69%;χ2=15.647,P〈0.001）、再出血（12.07%vs 46.15%;χ2=11.916,P=0.001）、脑积水（17.24%vs 50.00%;χ2=9.689,P=0.002）、晚期手术（63.79%vs 88.46%;χ2=5.353,P=0.021）、Fisher分级3~4级（17.24%vs 61.54%;χ2=16.483,P〈0.001）和Hunt-Hess分级Ⅳ~Ⅴ级（20.69%vs 53.85%;χ2=9.235,P=0.002）是a SAH患者转归不良的危险因素。多变量Logistic回归分析显示脑血管痉挛（OR=3.28,95%CI=1.18~10.23;P=0.037）、晚期手术（OR=2.26,95%CI=1.21~3.89;P=0.028）、Hunt-Hess分级Ⅳ~Ⅴ级（OR=3.42,95%CI=1.28~8.65;P=0.013）是a SAH患者转归不良的可能独立危险因素。结论脑血管痉挛、晚期手术和Hunt-Hess分级Ⅳ~Ⅴ级是a SAH患者临床转归不良的独立危险因素;早期手术可改善a SAH患者的临床转归。

Objective To explore the correlation between early surgery and clinical outcomes in patients with aneurysmal subarachnoid hemorrhage（ a SAH）. Methods Inpatients with a SAH were enrolled retrospectively accepted endovascular interventional therapy or aneurysm clipping. Their demographic and clinical data were collected. Clinical outcomes were assessed by modified Rankin scale（ mRs）at 6 months. Univariate and multivariate logistic regression analysis were performed to determine the risk factors that influenced clinical outcomes of patients with a SAH. Results 84 patients with a SAH were included. 24 patients underwent early surgery,60 patients delayed surgery. 58 patients had good outcome and 26 patients had poor outcome. Univariate analysis showed that good outcome rate at 6months（ 87. 50% vs 61. 67%; χ2= 5. 353,P = 0. 021） of the early surgery was higher than that of the delayed surgery. High systolic blood pressure（ t =- 3. 268; P = 0. 002）,cerebral vasospasm（ 15. 52% vs 57. 69%; χ2= 15. 647,P〈0. 001）,rebleeding（ 12. 07%vs 46. 15%; χ2= 11. 916,P = 0. 001）,hydrocephalus（ 17. 24% vs 50. 00%; χ2= 9. 689,P = 0. 002）,delayed surgery（ 63. 79% vs88. 46%; χ2= 5. 353,P = 0. 021）,Fisher grade 3 to 4（ 17. 24% vs 61. 54%; χ2= 16. 483,P〈0. 001） and Hunt- Hess grade IV to V（ 20. 69% vs 53. 85%; χ2= 9. 235,P = 0. 002） were the risk factors for patients with poor outcome. Multivariate logistic regression analysis showed that cerebral vasospasm（ OR 3. 28,95% CI 1. 18 ~ 10. 23; P = 0. 037）,delayed surgery（ OR 2. 26,95% CI 1. 21 ~3. 89; P = 0. 028）,Hunt- Hess grade IV to V（ OR 3. 42,95% CI 1. 28 ~ 8. 65; P = 0. 013） were the risk factors for patients with poor outcome. Conclusion Cerebral vasospasm,delayed surgery,Hunt- Hess grade IV to V are independent risk factors for poor clinical outcomes of patients with a SAH. Early surgery may improve the clinical outcomes for patients with a SAH.