外伤性与动脉瘤性蛛网膜下腔出血脑血管痉挛的对比分析

The comparison of cerebral vasospsam between traumatic and aneurysmal subarachnoid haemorrhage

目的对比分析外伤性与动脉瘤性蛛网膜下腔出血发生脑血管痉挛的危险因素。方法收集50例外伤性蛛网膜下腔出血(TSAH)和72例动脉瘤性蛛网膜下腔出血(ASAH)的临床资料,采用单因素分析法及多因素Logistic回归分析法分析两组患者发生脑血管痉挛(CVS)的危险因素。结果TSAH患者体温,白细胞计数和舒张压水平均高于ASAH患者(P=0.041;P=0.005;P=0.000)。单因素分析发现高血压和Fisher分级对TSAH组发生CVS有显著影响(P=0.031;P=0.012);吸烟,二次出血,Fisher分级及Hunt-Hess分级对ASAH组发生CVS有显著影响(P=0.044;P=0.002;P=0.025;P=0.010);多因素Logistic回归分析发现对于TSAH患者,仅Fisher分级是CVS的危险因素(OR=0.237,95%CI 0.065-0.857,P=0.028);对于ASAH患者,二次出血(OR=12.035,95%CI 1.645-88.028,P=0.014),Fisher分级(OR=0.200,95%CI 0.056-0.717,P=0.013)和Hunt-Hess分级(OR=0.259,95%CI 0.073-0.919,P=0.037)是发生CVS的危险因素。结论对于TSAH患者,仅Fisher分级是发生CVS的危险因素;而对于ASAH患者,其发生CVS的危险因素包括二次出血,Fisher分级和Hunt-Hess分级。

Objective The risk factors of cerebral vasospasm （CVS） between traumatic subarachnoid haemorrhage （TSAH） and aneurysmal subarachnoid haemorrhage （ASAH） were compared and analyzed.MethodsA total of 50 patients with TSAH and 72 patients with ASAH were selected to compare the clinicopathological features between two groups. The risk factors of CVS of two groups were analyzed by univariate analysis and multiariable Logistic regression analysis. ResultsThe temperature, white blood cell count and diastolic pressure in TSAH group were higher than those in ASAH group （P=0.041; P=0.005; P=0.000）. The univariate analysis showed that the factors were related to the CVS for patients with TSAH included hypertension and Fisher grade （P=0.031; P=0.012）, and for patients with ASAH included smoking, secondary hemorrhage, Fisher grade and HuntHess grade （P=0.044; P=0.002; P=0.025; P=0.010）. Multivariable Logistic regression analysis showed that Fisher grade （OR=0.237, 95%CI 0.065~0.857, P=0.028） was associated with CVS for TSAH patients. Secondary hemorrhage （OR=12.035, 95%CI 1.645~88.028, P=0.014）, Fisher grade （OR=0.200, 95%CI 0.0560.717, P=0.013） and HuntHess grade（OR=0.259, 95%CI 0.0730.919, P=0.037） were associated with CVS for ASAH patients.ConclusionFor patients with TSAH, Fisher grade is the only independent risk factors of CVS. Meanwhile, secondary hemorrhage, Fisher grade and HuntHess grade are the independent risk factors of CVS for TSAH patients.