影响重症动脉瘤性蛛网膜下腔出血老年患者预后的相关危险因素分析

Risk factors of the prognosis in elderly patients with severe aneurysmal subarachnoid hemorrhage

目的探讨重症动脉瘤性蛛网膜下腔出血(aSAH)老年患者预后的相关危险因素。方法收集2015年3月至2020年1月浙江大学附属金华医院神经外科收治的重症aSAH老年患者112例,根据格拉斯哥预后评分(GOS)分为预后良好组(IV~V级)43例和预后不良组(I~III级)69例。比较两组患者性别、年龄、吸烟、酗酒、高血压、糖尿病、冠心病、高脂血症、动脉瘤的位置、改良Fisher分级、Hunt-Hess分级、手术方式、手术时机和并发症因素的差异,再采用多因素logistic回归分析影响重症aSAH老年患者预后的相关危险因素。结果单因素分析显示,预后良好组和预后不良组患者年龄、高血压比例、改良Fisher分级、Hunt-Hess分级、手术时机和脑积水比例比较差异均有统计学意义(均P<0.05);多因素logistic回归分析显示年龄、高血压、改良Fisher分级和Hunt-Hess分级均是重症a SAH老年患者预后不良的独立危险因素(均P<0.05)。结论高龄、高血压、高改良Fisher分级和Hunt-Hess分级可增加重症aSAH老年患者预后不良的风险,治疗此类高风险患者时应格外谨慎,采用合理的个体化评估和治疗。

Objective To investigate the risk factors of the prognosis in elderly patients with severe aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 112 patients aged≥60 years with severe aSAH admitted in Department of Neurosurgery of Jinhua Hospital Affiliated to Zhejiang University School of Medicine from March 2015 to January 2020 were included in the study.According to Glasgow outcome scale(GOS),there were 43 cases with favorable prognosis(GOS IV-V)and 69 cases with poor prognosis(GOS I-II).The gender,age,smoking,alcohol abuse,hypertension,diabetes,coronary heart disease,hyperlipidemia,aneurysm location,modified Fisher grade,Hunt-Hess grade,surgical method,surgical timing,and complications were compared between the two groups.Univariate and multivariate logistic regression was used to analyze the risk factors for poor prognosis of elderly patients with severe aSAH.Results Univariate analysis showed that there were significant differences in age,hypertension,modified Fisher grade,Hunt-Hess grade,surgical timing and hydrocephalus between two groups(all P<0.05).Multivariate logistic regression analysis showed that age,hypertension,modified Fisher grade and Hunt-Hess grade were independent risk factors for poor prognosis in elderly patients with severe aSAH(all P<0.05).Conclusion Advanced age,hypertension,highly modified Fisher grade,and HuntHess grade increase the risk of poor prognosis in elderly patients with severe aSAH.These high risk patients should be treated with extreme caution and reasonably individualized evaluation and treatment.