动脉瘤性蛛网膜下腔出血术后并发分流依赖性脑积水的危险因素分析

Analysis on risk factors for shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage

目的探讨动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)术后并发分流依赖性脑积水(shunt-dependent hydrocephalus,SDH)的危险因素。方法回顾性分析354例aSAH病人的临床资料,按3个月内是否发生SDH分为SDH组(n=51)和非SDH组(n=303)。对两组临床资料行单因素和Logistic回归分析,判断发生SDH的危险因素。结果单因素分析结果显示:年龄、动脉瘤部位、入院GCS评分、Hunt-Hess分级、改良Fisher分级及术后脑脊液引流方式与SDH的发生密切相关(P<0.05)。Logistic回归分析提示:年龄≥60岁(OR=2.793,95%CI:1.353-5.768)、后循环动脉瘤(OR=3.887,95%CI:1.260-11.996)、Hunt-Hess分级Ⅲ~Ⅴ级(OR=4.087,95%CI:1.570-10.640)、改良Fisher分级Ⅲ~Ⅳ级(OR=3.762,95%CI:1.768-8.006)和术后持续脑脊液引流(OR=2.504,95%CI:1.048-5.984)是SDH的独立危险因素(P<0.05)。结论SDH是aSAH术后常见的严重并发症,其危险因素包括高龄、后循环动脉瘤、高Hunt-Hess分级和改良Fisher分级。合并这些危险因素的病人需特别关注及长时间随访,以获得及时、有效的干预。

Objective To explore the risk factors for shunt-dependent hydrocephalus(SDH)after the surgery of aneurysmal subarachnoid hemorrhage(aSAH).Methods Clinical data of 354 patients with aSAH were analyzed retrospectively,and the patients were divided into SDH group(n=51)and non-SDH group(n=303)according to whether occurred SDH within 3 months.Univariate analysis and Logistic regression analysis were performed on the clinical index of the two groups to judging the risk factors for SDH.Results Univariate analysis showed that age,aneurysm location,GCS scores,Hunt-Hess grade,modified Fisher grade and the method for CSF drainage were significantly related to SDH(P<0.05).Logistic regression analysis indicated age greater than or equal to 60(OR=2.793,95%CI:1.353-5.768),posterior circulation aneurysm(OR=3.887,95%CI:1.260-11.996),Hunt-HessⅢtoⅤgrade(OR=4.087,95%CI:1.570-10.640),modified FisherⅢtoⅣgrade(OR=3.762,95%CI:1.768-8.006)and the method of CSF drainage(OR=2.504,95%CI:1.048-5.984)were the independent risk factors for SDH(P<0.05).Conclusions SDH is a common serious complication after aSAH,and the risk factors include advanced age,posterior circulation aneurysm,high Hunt-Hess grade and high modified Fisher grade.The patients with these factors need more observation and longer follow-up to obtain timely and effective intervention.