颅内动脉瘤破裂蛛网膜下腔出血病人早期发生神经源性肺水肿危险因素分析

Risk factors for aneurysmal subarachnoid hemorrhage patients with neurogenic pulmonary edema

目的:探讨动脉瘤破裂蛛网膜下腔出血(aSAH)病人早期发生神经源性肺水肿(NPE)的危险因素。方法:对115例aSAH病人进行回顾性分析,收集临床资料,根据入院24 h内是否发生NPE分为发生NPE组与未发生NPE组,采用单因素分析比较2组病人间临床资料及结局的差异,多因素logistic回归分析筛选病人发生NPE的独立危险因素,并采用ROC曲线评估各独立危险因素的预测效能。结果:115例病人中有14例(12.2%)在入院24 h内发生NPE。Hunt-Hess分级Ⅳ~Ⅴ、肌钙蛋白Ⅰ升高、动脉瘤位置(后循环)是aSAH病人入院24 h内发生NPE的独立危险因素(P<0.05)。ROC曲线分析结果显示,上述3种因子联合检测因子模型预测aSAH病人发生NPE的曲线下面积为0.828(95%CI:0.693~0.963),敏感度为64.3%,特异度为92.1%,优于各项单一指标。结论:后循环动脉瘤是aSAH病人早期发生NPE的重要危险因素,此类病人入院时临床分级更严重,常伴肌钙蛋白Ⅰ升高,临床上应高度警惕此类病人。

Objective:To explore the incidence and risk factors of neurogenic pulmonary edema(NPE)in patients with aneurysmal subarachnoid hemorrhage(aSAH)in early stage.Methods:A retrospective analysis was conducted on 115 patients with aSAH,and clinical data was collected.According to whether NPE occurred within 24 h from admission,they were divided into the group with NPE and the group without NPE.Univariate analysis was used to compare the differences in clinical data and outcomes between two groups,and multivariate logistic regression analysis was used to reveal the independent risk factors for NPE,and the predictive efficacy was evaluated using receiver operating characteristic(ROC)curve.Results:Fourteen patients(12.2%)presented with NPE within 24 h from admission.Hunt-Hess gradeⅣ-Ⅴ,elevated troponinⅠ,and aneurysm location(posterior circulation)were independent risk factors of NPE in patients with aSAH within 24 h from admission(P<0.05).The ROC curve analysis results showed that the combined detection factor model of the above three factors predicted the area under the curve for NPE in aSAH patients was 0.828(95%CI:0.693-0.963),with a sensitivity of 64.3%and a specificity of 92.1%,which was superior to various single indicators.Conclusions:Patients with ruptured aneurysm in the posterior circulation was a significant risk factor for NPE in patients with aSAH,frequently with more severe clinical grade and elevated troponin I at admission.Clinically,such patients should be highly vigilant.