血小板体积指数、脑灌注压对动脉瘤性蛛网膜下腔出血后患者迟发性脑缺血的预测价值

Predictive value of platelet volume index,cerebral perfusion pressure and delayed cerebral ischemia in patients with subarachnoid hemorrhage

目的探讨分析血小板体积指数(platelet volume index,PVI)、脑灌注压(cerebral perfusion pressure,CPP)对动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)后患者迟发性脑缺血(delayed cerebral ischemia,DCI)的预测作用。方法选取284例aSAH患者,按照是否出现DCI分为DCI组和No DCI组,检测PVI、CPP与aSAH后患者DCI对患者预后的影响。结果No DCI组动脉瘤位置、Hunt Hess分级、改良Fisher分级、低白蛋白症、低钠血症、三酰甘油(TG)、血小板计数(PLT)、血小板平均体积(MPV)、PVI、颅内压(ICP)及CPP,与DCI组比较差异有统计学意义(P<0.05);Hunt Hess分级≥Ⅲ级、改良Fisher分级≥Ⅲ级、低白蛋白症、低钠血症、PVI为aSAH患者DCI发生的独立危险因素(P<0.05),CPP为aSAH患者DCI发生的保护因素(P<0.05)。No DCI组与DCI组预后良好比率差异存在统计学意义(P<0.01)。结论PVI、CPP对aSAH患者DCI及其预后具有较高的预测价值,值得临床进一步研究。

Objective To investigate the predictive effects of platelet volume index(PVI),cerebral perfu sion pressure(CPP)and delayed cerebral ischemia(DCI)in patients with subarachnoid hemorrhage.Methods 284 patients with subarachnoid hemorrhage were divided into DCI group and No DCI group according to whether there was DCI.The effects of PVI,CPP and DCI after aneurysmal subarachnoid hemorrhage on prognosis of the pa tients were examined.Results No DCI group aneurysm location,Hunt Hess classification,modified Fisher classi fication,hypoalbuminemia,hyponatremia,TG,MPV,PLT,PVI,ICP,and CPP were significantly different from the DCI group(P<0.05);Hunt Hess grade≥Ⅲ,modified Fisher grade≥3,hypoalbuminemia,hyponatremia,PVI are independent risk factors for DCI in patients with aSAH(P<0.05),CPP is a protective factor for DCI in patients with aSAH(P<0.05).There were good prognosis in both the No DCI group and the DCI group,and the difference was statistically significant(P<0.01).Conclusion PVI and CPP have high predictive value for DCI and prognosis of aSAH patients,which is worthy of further clinical research.