早期脑血流量检测在预测蛛网膜下腔出血迟发性脑缺血患者预后的作用研究

Role of early cerebral blood flow measurement in predicting the prognosis of patients with delayed cerebral ischemia after subarachnoid hemorrhage

目的探讨早期脑血流量检测对蛛网膜下腔出血(SAH)迟发性脑缺血(DCI)患者预后的预测作用。方法选择2008年1月～2012年11月来我院接受治疗的SAH后DCI患者150例。根据5年后患者临床结局分为存活组(n=96)和死亡组(n=54)。比较两组患者在临床特征方面的差异。绘制ROC曲线,计算曲线下面积评估各参数的预测效力。应用单因素、多因素非条件Cox回归分析预测SAH后DCI患者预后的危险因素。采用Kaplan-Meier法绘制累积生存曲线,采用Log-Rank法比较生存率差异。结果 150例患者术后5年96例(64%)存活,54例(36%)死亡。单因素、多因素Cox回归分析结果显示,脑血流量(CBF)<15.82ml/100g/min、PAASH分级≥4级、Fisher分级≥III级不利于患者预后(P<0.05)。随访5年后,CBF<15.82 ml/100 g/min的患者累积生存率为18%(9/50),显著低于CBF≥15.82 ml/100 g/min患者的累积生存率45%(45/100)(P<0.05)。结论入院时CBF可作为预测SAH后DCI患者预后的重要指标。

Objective To investigate the role of early cerebral blood flow （CBF） measurement in predicting the prognosis of patients with delayed cerebral isehemia （DCI） after subaraehnoid hemorrhage （SAH）. Methods A total of 150 patients with DCI after SAH who were treated in our hospital from January 2008 to November 2012 were enrolled, and according to the clinical outcome at 5 years after surgery, these patients were divided into survival group with 96 patients and death group with 54 patients. Clinical features were compared between the two groups. The receiver operating characteristic （ROC） curve was plotted, and the area under the curve was calculated to evaluate the predictive efficiency of related parameters. Univariate and multivariate Cox regression analyses were used to i- dentify the risk factors for the prognosis of patients with DCI after SAH. The Kaplan-Meier method was used to plot cumulative survival curves, and the log-rank test was used for the comparison of survival rates. Results Among these 150 patients, 96 （64%） survived and 54 （36%） died at 5 years after surgery. The univariate and multivariate Cox regression analyses showed that CBF 〈 15.82 ml/ 100g,/min, PAASH grade ≥4, and Fisher grade ≥ Ⅲ were risk factors for the prognosis of the patients （P 〈 0.05）. After 5 years of follow-up, the patients with a CBF of 〈 15.82 ml/100g/min had a significantly lower cumulative survival rate than those with a CBF of ≥ 15.82 ml/100g/min [ 18% （9/50） vs 45% （45/100）, P 〈0.05]. Conclusions CBF on admission can be used as an important indicator for predicting the prognosis of patients with DCI after SAH.