动脉瘤性蛛网膜下腔出血术后分流依赖性脑积水的危险因素分析

Risk factors analysis of shunt-dependent hydrocephalus in patients with aneurysmal subarachnoid hemorrhage after operation

目的:分析动脉瘤性蛛网膜下腔出血术后分流依赖性脑积水(shunt-dependent hydrocephalus,SDHC)的发生率,并探讨其发生的危险因素。方法:回顾性分析经血管内介入治疗和开颅夹闭手术治疗的108例动脉瘤性蛛网膜下腔出血患者的资料。比较未发生SDHC(No-SDHC组)、发生SDHC(SDHC组)患者的人口统计学及临床特征,采用单因素、多因素logistic回归分析法分析SDHC发生的危险因素。结果:108例患者以女性为主(68例,63.0%),平均年龄为(59.6±8.9)岁,中位随访时间为63.0个月,随访期间SDHC发生率为30.6%(33例)。SDHC组Hunt-Hess分级4～5级、Fisher分级3～4级、急性脑积水及开颅夹闭手术比例均高于No-SDHC组(P<0.01)。单因素分析表明,Hunt-Hess分级4～5级、Fisher分级3～4级、大脑中动脉瘤、合并急性脑积水、开颅夹闭手术治疗及无脑脊液引流是动脉瘤性蛛网膜下腔出血患者术后发生SDHC的危险因素(P<0.05)。多因素回归分析表明,Fisher分级3～4级(OR=6.406, 95%CI 1.800～22.799,P=0.004)及无脑脊液引流(OR=14.267, 95%CI 1.196～170.268,P=0.036)是SDHC发生的独立风险因素。结论:高级别Fisher分级(3～4级)及行无脑脊液引流的患者易发生SDHC,应加以关注。

Objective:To analyze the incidence and risk factors of shunt-dependent hydrocephalus(SDHC)in patients with aneurysmal subarachnoid hemorrhage after operation.Methods:The data of 108 patients who underwent endovascular intervention treatment or surgical clipping for ruptured aneurysms were retrospective analysis.The demographic and clinical characteristics of patients in No-SDHC and SDHC groups were compared.Uni-and multivariate logistic regression analysis were performed to evaluate the risk factors for the occurrence of postoperative SDHC.Results:Among the 108 patients,female was dominant(63.0%)with mean age of(59.6±8.9)years.During a median follow-up period of 63.0 months,SDHC developed in 33 patients(30.6%).Compared with No-SDHC group,the patients in SDHC group had higher Hunt-Hess grade 4-5,Fisher grade 3-4,acute hydrocephalus,and surgical clipping rates(P<0.01).Univariate logistic regression analysis showed that Hunt-Hess grade 4-5,Fisher grade 3-4,middle cerebral aneurysm,acute hydrocephalus,surgical clipping,and without cerebrospinal fluid drainage were risk factors for SDHC(P<0.05).Multivariate logistic regression analysis showed that Fisher grade 3-4(OR=6.406,95%CI 1.800-22.799,P=0.004)and without cerebrospinal fluid drainage(OR=14.267,95%CI 1.196-170.268,P=0.036)were predictive factors for SDHC.Conclusions:The patients with high Fisher grade(3-4)and without cerebrospinal fluid drainage may prone to SDHC,which should be paid attention to.