脑梗死发生时间对动脉瘤性蛛网膜下腔出血患者临床结局的影响

Effect of the onset time of cerebral infarction on clinical outcome in patients with aneurysmal subarachnoid hemorrhage

目的探究脑梗死发生时间对动脉瘤性蛛网膜下腔出血患者(aSAH)临床结局的影响。方法纳入2010年3月至2016年6月来我院进行就诊的aSAH患者395例,其中发生早期脑梗死患者74例,迟发性脑梗死患者77例,两者并发患者29例。分析aSAH术后脑梗死患者临床特征;采用多因素Logistic回归分析术后脑梗死发生的独立危险因素和长期预后的独立危险因素。结果多因素Logistic回归分析显示Hunt～Hess≥Ⅲ级和手术夹闭术是早期脑梗死发生的独立危险因素(P<0.05);Hunt～Hess≥Ⅲ级和血管痉挛是迟发性脑梗死发生的独立危险因素(P<0.05);早期脑梗死是术后a SHA患者长期不良预后的独立危险因素(OR,2.43;95%CI,1.16～4.72;P<0.001)。结论 Hunt～Hess≥Ⅲ级和手术夹闭术是aSAH患者术后并发早期脑梗死的独立危险因素,而Hunt～Hess≥Ⅲ级和血管痉挛则是迟发性脑梗死的独立危险因素。早期脑梗死比迟发性脑梗死更能预测aSAH患者术后的不良预后。

Objective To study the effect of the onset time of cerebral infarction on the clinical outcome in patients with aneurysmal subaraehnoid hemorrhage （aSAH）. Methods A total of 395 patients with aSAH visiting our hospital from March 2010 to June 2016 were included. Among them, 74 patients had early cerebral infarction, 77 patients had delayed cerebral infarction, and 29 patients had both early and delayed cerebral infarction. The clinical features of patients developing cerebral infarction post aSAH operation were analyzed; the independent risk factors for the development of cerebral infarction after operation and long-term prognosis were analyzed by multivariate logistic regression analysis. Results The multivariate logistic regression analysis revealed that Hunt-Hess ≥Ⅲ and clipping were independent risk factors for early cerebral infarction （ P 〈 0.05 ） ; Hunt-Hess ≥Ⅲ and vasospasm were independent risk factors for delayed cerebral infarction （ P 〈 0.05 ） ; early cerebral infarction was an independent risk factor for poor long-term prognosis in postoperative aSHA patients （odds ratio =2.43, 95% confidence interval： 1.16 -4.72, P〈0.001）. Conclusions Hunt-Hess ≥Ⅲ and clipping are independent risk factors for the development of early cerebral infarction after operation among aSAH patients, whereas Hunt-Hess ≥Ⅲ and vasospasm are independent risk factors for delayed cerebral infarction. Early cerebral infarction is superior to delayed cerebral infarction in predicting poor prognosis in postoperative aSHA patients.