颅内动脉瘤性蛛网膜下腔出血患者血压变异性与预后的相关性研究

Correlation of Blood Pressure Variability and Prognosis in Patients with Aneurysmal Subarachnoid Hemorrhage

目的本文旨在探讨动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者血压变异性对预后的影响。方法北京天坛医院2015年11月-2016年11月收治的123例经数字减影血管造影证实为原发性颅内动脉瘤破裂所致的SAH患者纳入此研究。回顾性分析123例患者的病历资料,对患者的年龄、性别、入院美国国立卫生研究院卒中量表(NationalInstitutesofHealthstrokescale,NIHSS)评分、入院格拉斯哥昏迷量表(Glasgowcomascale,GCS)评分、Hunt-Huss分级、Fisher分级、世界神经外科学会联盟(World Federation of Neurosurgical Societies,WFNS)分级、血压变异性等进行单因素的分析。根据随访患者发病3个月时改良Rankin量表评分作为临床预后评价的指标,1～3分为预后良好组,4～5分为预后不良组。结果 123例患者3个月后随访结果显示:预后不良17例,预后良好患者的入院NIHSS评分(P=0.007)、入院GCS评分(P=0.001)、WFNS分级(P=0.001)、血压变异系数(P=0.001),与预后不良患者相比,差异有统计学意义。单因素回归分析显示,仅血压变异系数与3个月后预后相关。Spearman相关性分析结果显示,血压变异系数、入院GCS评分和WFNS分级与3个月后预后相关。结论血压变异性是影响aSAH患者预后的重要因素,保持血压相对平稳是改善aSAH患者预后的重要途径之一。

Objective To investigate the effect of blood pressure variability on the prognosis of patients with aneurysmal subarachnoid hemorrhage （aSAH）. Methods This retrospective study included 123 aSAH patients caused by primary intracranial aneurysm rupture confirmed by DSA from Beijing Tian Tan Hospital from November 2015 to November 2016. A single factor analysis of age, gender, National Institutes of Health stroke scale （NIHSS） score on admission, Glasgow coma scale （GCS） score on admission, Hunt-Huss scale, Fisher scale, World Federation of Neurosurgical Societies （WFNS） scale and blood pressure variability （BPV） was made. The prognosis was evaluated by 90-day modified Rankin scale （mRS） score, with good prognosis defined as mRS 1-3 score and poor prognosis defined as mRS 4-5 score. Results The 3-month follow-up result showed that 106 patients （106/123） had good prognosis and there were significant difference in NIHSS score on admission （P=0.007）, GCS score on admission （P=0.001）, WFNS grade （P=0.001） and BPV （P=0.001） between the two groups. The single factor regression analysis showed that only BPV were associated with 3-month prognosis of aSAH patients. Spearman correlation analysis showed that BPV, GCS score on admission and WFNS grade were associated with 3-month prognosis.Conclusions BPV is an important factor affecting the prognosis of aSAH patients. Keeping blood pressure relatively stable is an important way of improving the prognosis of aSAH patients.