影响动脉瘤性蛛网膜下腔出血1年预后的相关因素分析

Analysis of related factors affecting one-year prognosis in patients with aneurysmal subarachnoid hemorrhage

目的探讨影响动脉瘤性蛛网膜下腔出血(aSAH)患者1年预后的相关因素。方法回顾性分析2016年5月至2018年5月该院收治的78例aSAH患者临床资料,以出院后死亡或1年时改良Rankin量表分级为终点指标,分析性别、年龄、吸烟、高血压、糖尿病、责任动脉瘤部位及大小、Hunt-Hess分级、世界神经外科医师联盟(WFNS)分级、脑疝、治疗方式、手术时机等因素对预后的影响。其中WFNS高分级动脉瘤患者40例,按治疗方式分为保守治疗组(14例)和手术治疗组(26例);并将手术治疗患者按手术时机分为早期手术组(12例)和延期手术组(14例),分析预后差异。结果预后不良40例。单因素分析结果显示,入院时血糖、格拉斯哥昏迷评分(GCS)、高血压、Hunt-Hess分级、WFNS分级、四脑室铸型、脑疝与预后相关(P<0.05)。多因素logistic回归分析显示,Hunt-Hess分级(OR=4.343,95%CI:1.190~15.847,P=0.026)、WFNS分级(OR=5.514,95%CI:1.534~19.814,P=0.009)、脑疝(OR=14.003,95%CI:1.374~142.678,P=0.026)是预后不良的独立危险因素。WFNS高分级动脉瘤患者手术治疗组预后良好率明显高于保守治疗组(42.3%vs.7.1%,χ^2=5.358,P=0.021),且早期手术组预后良好率明显高于延期手术组(75.0%vs.14.3%,χ^2=9.758,P=0.002)。结论Hunt-Hess分级、WFNS分级、脑疝是aSAH患者预后不良的独立危险因素,早期积极手术治疗高分级动脉瘤患者,可降低其不良预后的发生率。

Objective To explore the related factors affecting the one-year prognosis of patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods The clinical data of 78 patients with aSAH admitted to this hospital from May 2016 to May 2018 were retrospectively analyzed.Using the Rankin scale grade or post-discharge death as outcome indexes,the influences of factors such as gender,age,smoking,hypertension,diabetes mellitus,location and size of ruptured aneurysm,Hunt-Hess grade,World Federation of Neurosurgical Societies(WFNS)grade,cerebral herniation,treatment methods and timing of operation on the one-year prognosis of patients with aSAH were analysed.Additionally,40 aSAH patients with high-grade of WFNS were divided into the conservative treatment group(14 cases)and the surgical treatment group(26 cases)according to the treatment methods,and the surgical treatment patients were divided into the early operation group(12 cases)and the delayed operation group(14 cases)according to the timing of operation.The diffe-rence of prognosis was compared among these groups.Results Among all patients,40 cases had poor prognosis.Univariate analysis showed that blood glucose on admission,Glasgow Coma Scale(GCS)score,hypertension,Hunt-Hess grade,WFNS grade,cast form of the fourth ventricule,cerebral herniation were related to prognosis(P<0.05).Multivariate logistic analysis showed that Hunt-Hess grade(OR=4.341,95%CI:1.190-15.847,P=0.026),WFNS grade(OR=5.514,95%CI:1.534-19.814,P=0.009),and cerebral herniation(OR=14.003,95%CI:1.374-142.678,P=0.026)were independent risk factors for poor prognosis.Among these high-grade aSAH patients,the rate of good prognosis in the surgical treatment group was significantlyhigher than that in the conservative treatment group(42.3%vs.7.1%,χ^2=5.358,P=0.021),and the rate of good prognosis in the early surgery group was significantly higher than that in the delayed surgery group(75.0%vs.14.3%,χ^2=9.758,P=0.002).Conclusion Hunt-Hess grade,WFNS grade and cerebral herniation are independent risk factors for poor prognosis in patients with aSAH.Patients with high-grade aSAH receiving early surgical treatment could reduce the rate of poor prognosis.