动脉瘤性蛛网膜下腔出血继发脑血管痉挛危险因素分析

The analysis of cerebral vasospasm risk factor after aneurysms subarachnoid hemorrhage

目的:探讨动脉瘤性蛛网膜下腔出血(a SAH)患者脑血管痉挛(CVS)的发生情况及相关危险因素,为治疗和预防CVS提供一定的理论依据。方法:对115例a SAH患者的临床病理资料进行回顾性分析,对各个临床病理因素中CVS的发生率和危险因素分别进行单因素卡方检验和多因素logistic分析,评估CVS易发因素。结果:CVS发生情况的单因素分析结果显示115例患者中发生CVS 52例,发生率为45.21%,其中发生CVS与Hunt-Hess分级、改良Fisher分级、是否使用尼莫地平和治疗方式有关(P<0.05),而与患者年龄、性别、高血压病史、吸烟史、血钾、血糖、血白细胞计数无关(P>0.05)。CVS发生情况的logistic回归分析结果显示治疗方式与CVS发生无关(P>0.05);而Hunt-Hess分级、改良Fisher分级回归系数b<0、OR<1,为CVS发生的独立危险因素(P<0.05),使用钙离子拮抗剂尼莫地平回归系数b<0、OR<1,为CVS发生的保护因素(P<0.05)。结论:a SAH患者在治疗过程中好发CVS,使用钙离子拮抗剂尼莫地平是减少CVS发生的保护因素,而Hunt-Hess分级、改良Fisher分级是CVS发生的高危因素。

Objective： To analyze the occurrence and risk factor of cerebral vasospasm （CVS） after aneu-rysms subarachnoid hemorrhage （aSAH）. It was useful to provid theoretical basis for the treatment and preventa-tion of the CVS.Methods： The clinical data of 115 patients were retrospectively analyzed. The Chi-squared test and logistic multivariate analysis were used to analyze and assess cerebral vasospasm rate and high-risk factors. Results： The Chi-squared test showed that 52 patients appeared the CVS, and the occurrence rate of the CVS was 45.21% in 115 patients. Hunt grades, improved modiifed FISH grades, therapy methods and nimodpine were re-lated to the CVS （P〈0.05）. But age, gender, history of hypertension, history of smoking, serous potassium, blood glucose and white blood cell were irrelated to the CVS （P〉0.05）. Multivariate logistic analysis revealed that ther-apy methods were irrelated to the CVS （P〉0.05）. However, Hunt grades, improved modiifed FISH grades （b〉0, OR〉1） were independent risk factor of the CVS （P〈0.05）, and nimodpine was a protective factor （b〈0, OR〈1） of the CVS （P〈0.05）.Conclusion： aSAH patients are vulnerable to the CVS. Nimodipine is a protective factor of the CVS, however, Hunt grades and improved modiifed FISH grades are high risk factors of the CVS.