蛛网膜下腔出血预后因素分析

Prognosis Factors Analysis of Subarachnoid Hemorrhage

目的探讨蛛网膜下腔出血(subarachnoid hemorrhage,SAH)预后因素及改善预后的方法。方法将2012年7月-2015年8月神经内科收治的120例SAH患者分为两组进行回归性分析,脑血管造影(digital subtraction angiography,DSA)后行介入治疗的65例为介入治疗组,未行介入治疗的55例为未行介入组,行预后危险因素分析比较。结果影响SAH预后的因素较多,其中年龄、吸烟、高血压、糖尿病、未行介入治疗增加预后不良的风险;与良好结局的患者比较,不良结局的患者平均年龄更大(56.7岁vs 53.4岁),吸烟的比例更高(48.9%vs 13.3%),合并高血压和糖尿病的比例也更高(93.3%vs 66.7%,77.8%vs 39.9%),良好结局组行介入治疗的患者比例高于不良结局组(64.0%vs 37.8%)。多因素分析显示,这些因素依然影响不良结局的发生。结论 SAH再出血及脑血管痉挛是影响预后的重要因素,情况允许应尽早行血管内介入治疗。

Objective To explore the prognosis factors of subarachnoid hemorrhage（SAH） and the methods of improving the prognosis.Methods A total of 120 patients of SAH that were recruited during July 2015 and August 2016 were divided into two groups.The patients who were given interventional therapy treatment after having digital subtraction angiography were included in intervention treatment group.The patients who were not given any interventional therapy treatment were included into control group.Results There were many risk factors influencing the prognosis of SAH,among which,age,smoking,hypertension,diabetes mellitus,and no interventional therapy treatment could increase the risk of poor prognosis.Compared with those patients who did not have bad outcomes,the patients with bad outcomes were older（56.7 vs 53.4 years old）,and had higher proportion of smoking（48.9% vs 13.3%）,higher proportion of hypertension and diabetes mellitus（93.3% vs 66.7%,77.8% vs 39.9%）.And patients with bad outcomes received lower proportion of interventional therapy treatment（37.8% vs 64.0%）.Multivariate analysis showed that these risk factors continued to influence the occurrence of bad outcomes.Conclusion Re-bleeding and spasm of blood vessel of brain are the main factors to influence the prognosis.Therefore,the suggestion is to give interventional therapy treatment as early as possible.