异常动脉二氧化碳分压与青年蛛网膜下腔出血预后的相关分析

Association of Abnormal Carbon Dioxide Levels with Poor Neurological Outcomes in Young Patients with Aneurysmal Subarachnoid Hemorrhage

目的探讨异常动脉二氧化碳分压(Arterial Partial Pressure of Carbon Dioxide,PaCO2)与青年蛛网膜下腔出血(Aneurysmal Subarachnoid Hemorrhage,SAH)患者预后的相关性。方法回顾性分析2009年1月—2019年1月期间医院ICU收治的青年蛛网膜下腔出血的病例,根据动脉血气分析测量均值划分病例组和对照组,比较两组年龄、性别、H&K分级、出血原因、出血高危因素、mRS(ModifiedRankin Scale,mRS)、迟发性脑缺血发生率、机械通气时间、ICU住院时间、总住院时间、死亡率的差异,并进行统计学分析。结果两组间患者性别、出血原因、出血的高危因素无统计学差异,但病例组发病年龄较早,H&K分级更轻,二氧化碳分压适中,mRS评分更优,机械通气时间、ICU住院时间、总住院时间更短,迟发性脑缺血发生率和死亡率更低。结论二氧化碳分压过高或过低均不利于青年蛛网膜下腔出血患者的恢复。

Objective To investigate the association of abnormal carbon dioxide levels with poor neurological outcomes in young patients with aneurysmal subarachnoid hemorrhage(ASH).Methods We retrospectively selected consecutive young patients hospitalized in the intensive care unit(ICU)for SAH from January 2009 to January 2019.Subjects were divided into case group and control group according to the mean value of arterial blood gas analysis,age,sex,Hunt and Kosnik grade,mRS(modified Rankin scale),the reasons and high-risk factors of hemorrhage,mechanical ventilation duration,ICU stay duration,of The two groups were compared in terms of hospital stay duration,maximum PaCO2 levels,minimum PaCO2 levels,the incidence of delayed cerebral ischemia,and the hospital mortality and the data were analyzed statistically.Results There was no significant difference in the sex,reasons and high-risk factors of hemorrhage between the groups(P>0.05).However,compared with control group,age of onset was ealier,Hunt and Kosnik grade lower,mRS better,mechanical ventilation duration shorter,ICU stay duration shorter,and hospital stay duration shorter,and maximum PaCO2 levels was obviously lower,while minimum PaCO2 levels was obviously higher.The incidence of delayed cerebral ischemia and the hospital mortality were better in case group(P<0.05).Conclusion Both the maximum and minimum PaCO2 levels during ICU management in patients with SAH are significantly associated with unfavorable neurological outcomes.