实验室参数预测动脉瘤性蛛网膜下腔出血患者分流依赖性脑积水发生的价值

Predictive value of laboratory parameters for shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage

目的探讨实验室参数对动脉瘤性蛛网膜下腔出血(a SAH)后分流依赖性脑积水(SDHC)发生的预测价值。方法应用单因素、多因素非条件Logistic回归分析探讨影响a SAH患者SDHC发生的危险因素。结果 (1)SDHC组在年龄、脑室内出血比例、术前Hunt-Hess分级≥III级比例、术前空腹血糖、术后3 d血钠、术后3 d血钾、术后3 d空腹血糖方面与无SDHC组比较差异有统计学意义(χ~2=2.49,11.15,22.39,5.96,2.45,-2.69,5.47;P<0.05);(2)年龄≥60岁、脑室内出血、术前Hunt-Hess分级≥III级、术前血钾<3.48 mmol/L、术前空腹血糖≥160.25 mg/d L、术后3 d血钠≥145.54 mg/L、术后3 d血钾<3.02 mmol/L、术后3d空腹血糖≥167.55 mg/d L是影响a SAH后SDHC发生的危险性因素(P<0.05)。结论夹闭术术前及术后第3d血钠、空腹血糖、血钾与a SAH患者SDHC发生密切相关。

Objective To assess the predictive value of laboratory parameters for the development of shunt-dependent hydrocephalus （SDHC） after aneurysmal subarachnoid hemorrhage （aSAH）. Methods A total of 150 patients with aSAH who underwent clipping in our hospital from January 2014 to December 2017 were included in the study. Patients were divided into SDHC group （ n = 40） and non-SDHC group （ n = 110） according to the presence or absence of SDHC at 28 days after the onset of aSAH. The clinical data of pa- tients were compared between the two groups. The receiver operating characteristic curve was plotted and laboratory parameters were assessed for their ability to predict SDHC after aSAH. Univariate and multivariate unconditional logistic regression analyses were performed to determine the risk factors for SDHC in patients with aSAH. Results Age, proportion of intraventricular hemorrhage, propor- tion of preoperative Hunt-Hess grade≥ Ⅲ aSAH, preoperative fasting blood glucose, 3-day postoperative blood sodium and potassium levels, and 3-day postoperative fasting blood glucose were significantly different between the SDHC group and non-SDHC group （X^2 = 2.49, 11.15, 22.39, 5.96, 2.45, - 2.69, and 5.47, respectively, all P 〈 0.05 ）. Univariate and multivariate logistic regression analyses showed that age 〉t60 years, intraventricular hemorrhage, preoperative Hunt-Hess grade ≥ Ⅲ aSAH, preoperative blood po- tassium 〈 3.48 mmol/L, preoperative fasting blood glucose ≥ 160.25 mg/dL, 3-day postoperative blood sodium ≥ 145.54 mg/L, 3-day postoperative blood potassium 〈 3.02 mmol/L, and 3-day postoperative fasting blood glucose ≥ 167.55 mg/dL were risk factors for the development of SDHC after aSAH （ all P 〈 0.05 ）. Conclusions Blood sodium and potassium levels and fasting blood glucose before and 3 days after clipping are closely associated with the development of SDHC in patients with aSAH.