动脉瘤性蛛网膜下腔出血腰大池持续引流后慢性分流依赖性脑积水影响的调查研究

The Investigation on the Influence Factors of Shunt-dependent Chronic Hydrocephalus in Patients with Aneurysmal Subarachnoid Hemorrhage after Continuous Lumbar Drainage

目的分析动脉瘤性蛛网膜下腔出血腰大池持续引流后慢性分流依赖性脑积水检出情况及其影响因素,为采取针对性的干预措施提供参考依据。方法选取我院神经外科2012年2月—2015年2月收治的375例蛛网膜下腔出血病人为研究对象。均为动脉瘤破裂所致,接受腰大池持续引流治疗,制定自编问卷并应用于收集动脉瘤性蛛网膜下腔出血腰大池持续引流病人的临床资料。采用SPSS18.0统计软件包进行描述性统计方法和Logistic回归分析法分析收集到的临床资料,以期找出动脉瘤性蛛网膜下腔出血后慢性分流依赖性脑积水检出情况及其影响因素。结果动脉瘤性蛛网膜下腔出血检出率为14.67%(55/375)。老年(OR=7.12,P=0.000)、入院时Hunt-Hess分级(OR=4.84,P=0.000)、入院时改良Fisher分级(OR=5.81,P=0.000)、夹闭治疗(OR=6.72,P=0.000)及其每日脑脊液引流量(OR=6.56,P=0.000),是动脉瘤性蛛网膜下腔出血腰大池持续引流发生慢性分流依赖性脑积水危险因素。结论动脉瘤性蛛网膜下腔出血病人腰大池持续引流后发生慢性分流依赖性脑积水较为普遍,其发生受到多方面原因的影响,为此,在临床工作中,关注病人年龄、入院时Hunt-Hess分级、入院时改良Fisher分级具有重要意义,同时,权衡利弊选择治疗方法,术后充分引流脑脊液对慢性分流依赖性脑积水意义重大。

Objective To investigate the influence factor of shunt dependent chronic hydrocephalus （ SDCH）in patients with aneu -rysmal subarachnoid hemorrhage （ aSAH）after continuous lumbar drainage （ CLD） .Methods Three hundreds and seventy five pa -tients with aSAH after CLD in our hospital from February 2012 to February 2015 were selected.The clinical data was collected by theself made questionnaire.They were analyzed by descriptive statistical methods and Logistic regression analysis of SPSS18.0 statisti-cal software package in order to find out the detection rate of SDCH and its influence factors in patients with aSAH after CLD.Results The detection rate of aSAH was 14.67%（ 55/375）.Binary classification Logistic regression analysis showed that age （ OR =7.12,P =0.000） ,Hunt Hess classification on admission （ OR =4.84, P =0.000） , Fisher on admission improved grade （ OR =5.81, P =0.000） ,the clip treatment （ OR =6.72, P =0.000）and cerebrospinal fluid of daily （ OR =6.56, P =0.000）were risk factors of SDCH in pa -tients with aSAH after CLD.Conclusion SDCH is more common in patients with aSAH after CLD, which is affected by the variousfactors.Therefore,in clinical work, we pay attention to patients’ age, Hunt Hess classification at admission,improved Fisher classifi-cation at admission, and treatment.Postoperative drainage of cerebrospinal fluid is of great significance to SDCH.