ESRS评分联合BPV对aSAH介入栓塞术后DCI的警示作用

The warning effect of ESRS score combined with BPV on DCI after interventional embolization of intracranial in aSAH patients

目的探讨ESSEN卒中风险评分联合血压变异性指数(BPV)对颅内动脉瘤性蛛网膜下腔出血(aSAH)介入栓塞术后迟发性脑缺血(DCI)的警示作用。方法选择2019-01—2021-12绵阳市中心医院收治的129例拟行介入栓塞术治疗的aSAH患者,根据术后是否发生DCI分为DCI组(39例)和非DCI组(90例)。所有患者术前评估ESRS评分,测量BPV,收集临床相关信息,分析影响aSAH后DCI的相关因素以及ESRS评分、BPV预测aSAH后DCI的效能。结果DCI组年龄、入院时收缩压、Hunt-Hess分级Ⅲ~Ⅴ级、改良Fisher分级Ⅲ~Ⅴ级比例,ESRS评分(4.02±1.15分vs 2.42±0.71分)和BPV(21.53±6.09 vs 16.02±4.15)高于非DCI组(P<0.05)。Hunt-Hess分级Ⅲ~Ⅴ级(OR=3.438,95%CI:1.728~6.841)、ESRS评分(OR=2.284,95%CI:1.499~3.481)、BPV(OR=1.826,95%CI:1.261~2.644)是aSAH后是否发生DCI的危险因素(P<0.05)。ESRS评分、BPV单独预测aSAH后DCI的曲线下面积为0.655、0.734,联合两项预测a SAH后DCI的曲线下面积为0.878,高于单独ESRS评分、BPV单独预测(Z=4.319、3.185,P<0.05)。结论高ESRS评分和BPV与aSAH后发生DCI有关,联合ESRS评分和BPV可有效地预测aSAH后DCI的发生。

Objective To investigate the warning effect of ESSEN stroke risk score combined with blood pressure variability index on delayed cerebral ischemia(DCI) after interventional embolization of aneurysmal subarachnoid hemorrhage(aSAH).Methods 129 aSAH patients who were admitted to our hospital from January2019 to December 2021 were selected and divided into DCI group(39 cases) and non-DCI group(90 cases)according to postoperatively DCI.All patients were evaluated for ESRS score,BPV before surgery was measured,and clinical information was collected to analyze the related factors affecting DCI after aSAH and the efficacy of ESRS score and BPV in predicting DCI after aSAH.Results Age,systolic blood pressure at admission,hunt-Hess grade ⅲ to V,modified Fisher grade Ⅲ to Ⅴ,ESRS score(4.02±1.15 scores vs 2.42±0.71 scores)and BPV(21.53±6.09 vs 16.02±4.15) of DCI group were higher than those of non-DCI group(p<0.05).Hunt-Hess grade Ⅲ to Ⅴ(OR=3.438,95% CI:1.728~6.841),ESRS score(OR=2.284,95% CI:1.499~3.481)and BPV(OR=1.826,95% CI:1.261~2.644) were the risk factors for DCI after aSAH(P<0.05).The area under curve of ESRS score and BPV alone diagnosing DCI after aSAH were 0.655 and 0.734,and the area under curve of combined ESRS score and BPV was 0.878,which was higher than that predicted by ESRS score and BPV alone(Z=4.319,3.185,P<0.05).Conclusion High ESRS score and BPV are associated with DCI after aSAH,and combined ESRS score and BPV can effectively predict the occurrence of DCI after aSAH.