密闭空间发病与动脉瘤性蛛网膜下腔出血患者病情严重程度及短期预后的相关性分析

Association between sudden onset in confined spaces and disease severity and short-term clinical outcomes in patients with aneurysmal subarachnoid hemorrhage

背景动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)是一种常见的脑血管疾病,致死致残率较高。密闭空间封闭狭小,通风不良。临床发现很多aSAH患者在密闭空间发病,这是否与患者病情轻重及短期预后相关尚不确定。目的探讨密闭空间发病与aSAH患者病情轻重及短期预后之间的关系。方法回顾性分析2014年1月-2020年12月火箭军特色医学中心收治的aSAH患者临床资料。采用Hunt-Hess分级评估病情严重程度,格拉斯哥预后评分(Glasgow Outcome Scale,GOS)评估预后,并进行二元多因素logistic回归分析发病空间是否为aSAH患者病情轻重及短期预后的预测因素。结果密闭空间和开敞空间发病患者分别有30例和96例,两组性别构成(男/女:12/18 vs 38/58)和年龄[(59.0±15.4)岁vs(58.3±14.0)岁]差异无统计学意义(P均>0.05),但密闭空间发病组病情评估为重度的患者占比[30.0%(9/30)vs 8.3%(8/96),P=0.006]和短期预后不良占比[56.7%(17/30)vs 24.0%(23/96),P=0.001]显著高于开敞空间组,差异有统计学意义。多因素logistic回归分析显示,密闭空间发病与aSAH患者短期预后独立关联(OR=4.213,95%CI:1.554~11.421,P=0.005),但与病情轻重程度不相关(OR=3.153,95%CI:0.933~10.653,P=0.064)。结论本研究发现密闭空间发病与aSAH患者短期预后不良独立相关,但与病情轻重程度的关系尚未得到证实。

Background Aneurysmal subarachnoid hemorrhage(aSAH)is a common cerebrovascular disease with high mortality and morbidity rates.Confined spaces are often small,with low oxygen levels and poor ventilation.It has been found that many aSAH patients have sudden onset in confined spaces.The association between onset in confined spaces and disease severity and prognosis in aSAH patients remains unclear.Objective To investigate the association between sudden onset in confined spaces and disease severity as well as short-term clinical outcomes in aSAH patients.Methods Clinical data about patients with aSAH admitted to the PLA Rocket Force Characteristic Medical Center from January 2014 to December 2020 were retrospectively analyzed.The severity of the disease was assessed using the Hunt-Hess scale,and clinical outcome was evaluated using the Glasgow Outcome Scale(GOS).The patients were divided into groups according to disease severity and short-term clinical outcomes,and differences between the two groups were analyzed.Binary multivariate logistic regression was performed to analyze whether the confined space was a predictor of disease severity and short-term prognosis in aSAH patients.Results A total of 30 aSAH patients had sudden onset in confined spaces and 96 patients in open spaces,and there were no significant differences in sex(male/female:12/18 vs 38/58)and age(59.0±15.4 years vs 58.3±14.0 years)between the two groups(P>0.05).The proportion of aSAH patients with more severe disease and poor prognosis were significantly higher in the confined space group[9(30.0)vs 8(8.3),P=0.006;17(56.7)vs 23(24.0),P=0.001].Multivariable logistic regression analysis showed that aSAH onset in confined spaces was an independent risk factor for short-term clinical outcome(OR=4.213,95%CI:1.554-11.421,P=0.005),but it was not an independent risk factor for disease severity in aSAH patients(OR=3.153,95%CI:0.933-10.653,P=0.064).Conclusion The onset of aSAH in confined spaces is independently associated with the short-term clinical outcomes but not with the disease severity of aSAH patients.