高级别动脉瘤性蛛网膜下腔出血再破裂的危险因素分析

Risk factors for rebleeding after poor-grade aneurysmal subarachnoid hemorrhage

目的探讨高Fisher分级动脉瘤性蛛网膜下腔出血(aSAH)患者再破裂出血的相关危险因素,为早期预防再出血提供指导。方法对327例高Fisher分级aSAH患者的临床资料进行回顾性分析,依据入院3日内是否发生再出血分为再出血组(n=37)和未出血组(n=290),利用单因素和多因素的方法来筛选影响再出血的相关危险因素。结果颅内破裂动脉瘤术前再出血发生率为11.3%(37/327);多因素分析结果显示高血压病史(OR=2.51),癫痫(OR=3.32),动脉瘤形态(OR=3.24)和动脉瘤处理前行侧脑室外引流(OR=4.03)为颅内破裂动脉瘤患者术前再出血的独立危险因素。结论颅内破裂动脉瘤患者术前仍然有较高的再出血发生率,严重影响患者的预后;影响术前再出血的危险因素较多,应注意避免或采取必要干预措施。

Objective To explore the correlated predictors of rebleeding for high Fisher grade aneurysmal subarachnoid hemorrhage(aSAH)patients before operation,and provide basis for preventing rebleeding.Methods The clinical data of 327 patients with high Fisher grade aSAH were analyzed retrospectively.According to whether rebleeding occurred within 3 days after admission,they were divided into rebleeding group(n=37)and non bleeding group(n=290).Univariate and multivariate methods were used to screen the relevant risk factors affecting rebleeding.Results The incidence of rebleeding before operation of ruptured intracranial aneurysms was 11.3%(37/327);Multivariate analysis showed that history of hypertension(OR=2.51),epilepsy(OR=3.32),aneurysm morphology(OR=3.24)and lateral extracerebral drainage before aneurysm treatment(OR=4.03)were independent risk factors for preoperative rebleeding for patients with ruptured intracranial aneurysms.Conclusions There is still a little high incidence rate of rebleeding for patients with ruptured intracranial aneurysm before operation,and it affects the prognosis of these patients.There are many risk factors affecting the incidence rate of rebleeding,so we should adopt intervention measures to prevent these risk factors.