动脉瘤性蛛网膜下腔出血患者脑血管痉挛的危险因素分析

Predictors of angiographic vasospasm,symptomatic vasospasm and cerebral infarction in patients with aneurysmal subarachnoid hemorrhage

目的分析动脉瘤性蛛网膜下腔出血后脑血管痉挛的危险因素。方法选择郑州市第一人民医院2012-01—2018-03住院治疗的301例动脉瘤性蛛网膜下腔出血者为研究对象。分析患者入院时的基本资料、动脉瘤大小和数量、Hunt-Hess分级、改良Fisher分级、动脉瘤治疗方法、实验室检查结果与血管造影血管痉挛(AV)、有症状的血管痉挛(SV)、脑梗死的相关性,并分析SV、AV、脑梗死独立危险因素。结果入院时年龄≥53岁、改良Fisher分级3~4级、Hunt-Hess分级4~5级、白细胞计数水平≥11×10 9个/L、血糖水平≥7.0 mmol/L是AV、SV、脑梗死的危险因素(P<0.05)。此外,高血压史和吸烟是SV或脑梗死的危险因素;动脉瘤直径≥1 cm是AV或SV的危险因素(P<0.05)。多因素分析显示,入院时改良Fisher分级3~4级、Hunt-Hess分级4~5级、白细胞计数水平≥11×10 9个/L、高血压史是SV、AV、脑梗死的独立危险因素(P<0.05)。此外,血糖水平≥7.0 mmol/L也是AV的独立危险因素(P<0.05);动脉瘤直径≥1 cm也是SV的独立危险因素(P<0.05);年龄≥53岁、吸烟史也是脑梗死的独立危险因素(P<0.05)。结论动脉瘤性蛛网膜下腔出血后脑血管痉挛不同类型危险因素存在差异。

Objective To estimate the predictors of angiographic vasospasm(AV),symptomatic vasospasm(SV),and cerebral infarction in Chinese patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods 301 consecutive aSAH patients admitted to our hospital form January 2012 to March 2018 were reviewed.AV,SV and cerebral infarction were defined based on clinical data and neuroimaging findings.Univariate and multivariate analyses were performed to identify predictors of AV,SV or cerebral infarction.Results In univariate analysis,age≥53 years,poor modified Fisher grade(3-4),poor Hunt-Hess grade(4-5),leukocyte count level≥11×10 9/L,and serum glucose level≥7.0 mmol/L on admission were risk factors of AV,SV,or cerebral infarction(P<0.05).Additionally,a history of hypertension and being current or former smokers were risk factors for SV or cerebral infarction.Aneurysm size≥1 cm was risk factor for AV or SV(P<0.05).In multivariate analysis,poor modified Fisher grade(3-4),poor Hunt-Hess grade(4-5),leukocyte count level≥11×10 9/L,and history of hypertension were independent risk factors for SV,AV,and cerebral infarction(P<0.05).In addition,serum glucose level≥7.0 mmol/L was also an independent risk factor for AV,the aneurysm diameter≥1 cm was also an independent risk factor for SV,age≥53 years,smoking history was also a cerebral infarction independent risk factors for cerebral infarction(P<0.05).Conclusion Risk factors of different definitions of CVS were diverse in patients with aSAH.