动脉瘤性蛛网膜下腔出血患者术后发生延迟性脑缺血的相关因素及对预后的影响

Related factors of postoperative delayed cerebral ischemia and its influences on prognosis of patients with aneurysmal subarachnoid hemorrhage

目的探究动脉瘤性蛛网膜下腔出血(aSAH)患者动脉瘤夹闭术后发生延迟性脑缺血的相关因素及对预后的影响。方法回顾性分析2018年5月至2021年1月在延安大学咸阳医院行动脉瘤夹闭术治疗的53例aSAH患者的临床资料,根据延迟性脑缺血发生情况将患者分为脑缺血组15例和正常组(未出现延迟性脑缺血者)38例,采用多元Logistic回归、受试者工作特征曲线(ROC)分别分析影响延迟性脑缺血发生的危险因素及各危险因素对延迟性脑缺血发生的预测价值;根据术后28 d格拉斯哥预后评分(GOS)对患者预后进行评价,比较脑缺血组及正常组的预后,采用比例风险回归模型(Cox)分析术后延迟性脑缺血与预后的关系。结果脑缺血组患者在Hunt-Hess分级4~5级、患糖尿病、脑血管痉挛、动脉瘤大小>2.5 cm方面的人数比例明显高于正常组,差异均有统计学意义(P<0.05);经多元Logistic回归分析结果显示,Hunt-Hess分级4~5级、患糖尿病、脑血管痉挛是aSAH患者发生延迟性脑缺血的危险因素(P<0.05);经ROC曲线分析显示,Hunt-Hess分级、糖尿病、脑血管痉挛预测延迟性脑缺血发生的曲线下面积(AUC)分别为0.674、0.705、0.679;脑缺血组的预后不良发生率为86.67%,明显高于正常组的23.68%,差异有统计学意义(P<0.05);经多元Logistic回归分析结果显示,发生延迟性脑缺血是影响患者预后的危险因素(P<0.05)。结论aSAH患者动脉瘤夹闭术后延迟性脑缺血发生率较高,Hunt-Hess分级4~5级、患糖尿病、脑血管痉挛是aSAH患者发生延迟性脑缺血的危险因素,且发生延迟性脑缺血可影响患者预后。

Objective To explore the related factors of delayed cerebral ischemia and its influences on prognosis of patients with aneurysmal subarachnoid hemorrhage(aSAH)after aneurysm clipping.Methods A retrospective analysis was performed on the clinical data of 53 patients with aSAH undergoing aneurysm clipping in Xianyang Hospital of Yan'an University between May 2018 and January 2021.According to presence or absence of delayed cerebral ischemia,they were divided into cerebral ischemia group(15 cases)and normal group(38 cases).The risk factors of delayed cerebral ischemia and their predictive value for delayed cerebral ischemia were analyzed by multivariate logistic regression analysis and receiver operating characteristic curves(ROC curves),respectively.The prognosis of patients was evaluated according to scores of Glasgow Outcome Scale(GOS)at 28 d after surgery.And the prognosis between cerebral ischemia group and normal group was compared.The relationship between delayed cerebral ischemia and prognosis was analyzed by proportional hazards regression model(Cox).Results The proportions of cases with Hunt-Hess grading at grades 4-5,diabetes,cerebral vasospasm,and aneurysm>2.5 cm in cerebral ischemia group were significantly higher than those in normal group(P<0.05).The results of multivariate logistic regression analysis showed that Hunt-Hess grading at grades 4-5,diabetes and cerebral vasospasm were risk factors of delayed cerebral ischemia in aSAH patients(P<0.05).ROC curves analysis showed that area under the curve(AUC)values of Hunt-Hess grading,diabetes,and cerebral vasospasm for predicting delayed cerebral ischemia were 0.674,0.705,and 0.679,respectively.The incidence of poor prognosis in cerebral ischemia group was 86.67%(13/15),significantly higher than 23.68%(9/38)in normal group(P<0.001).Multivariate Logistic regression analysis showed that delayed cerebral ischemia was a risk factor of prognosis(P<0.05).Conclusion The incidence of delayed cerebral ischemia in aSAH patients after aneurysm clipping is relatively high.Hunt-Hess grading at grades 4-5,diabetes,and cerebral vasospasm are risk factors of delayed cerebral ischemia.Delayed cerebral ischemia can affect the prognosis of patients.