摘要
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.
作者
刘贤生
吴楚伟
邹隽风
苏高健
黄贤键
Liu Xiansheng;Wu Chuwei;Zou Junfeng;Su Gaojian;Huang Xianjian(Department of Neurosurgery,the Second People's Hospital of Shenzhen,Shenzhen,Guangdong 518035,China)
出处
《中国微侵袭神经外科杂志》
CAS
2020年第11期481-484,共4页
Chinese Journal of Minimally Invasive Neurosurgery
基金
国家自然科学基金(编号:81301062)
深圳市科技计划项目(编号:JCYJ20180228163034627)。