基于CT计算大脑前动脉瘤破裂后总出血量对预后的预测价值

Prognostic value of the total amount of bleeding of after anterior aneurysmal subarachnoid hemorrhage based on CT calculation

目的探讨大脑前动脉动脉瘤破裂后出血量对患者预后的预测价值。方法搜集陕西省人民医院2016年1月至2022年12月大脑前动脉动脉瘤破裂出血患者40例,整理一般临床资料,并将患者平扫CT数据以DICOM格式导入3D Slicer软件,使用该软件计算蛛网膜下腔和/或脑室和/或脑内血肿的总出血量。根据改良Rankin量表分为预后不良和预后良好两组,对预后相关因素进行二元Logistic回归模型分析,并以受试者工作特征曲线分析其诊断效能,计算出约登指数以确定总出血量与预后的截断值。结果性别、年龄、动脉瘤部位、手术方式在预后不良和预后良好两组间比较差异无统计学意义(P>0.05)。基础疾病、格拉斯哥昏迷量表(GCS)分级有无昏迷、总出血量以及出血的分布情况在两组间比较差异有统计学意义(P<0.05)。多因素二元Logistic分析显示,出血量多少与预后情况显著相关(OR值为1.101,95%CI 1.006~1.205;P<0.05)。受试者工作特征曲线分析显示二元Logistic回归模型区分预后不良患者的曲线下面积为0.803(P<0.05),截断值约为13.04ml。结论大脑前动脉动脉瘤破裂后总出血量是患者预后的独立危险因素。总出血量大于13.04ml与预后不良风险增加有关。

Objective To investigate the predictive value of the total amount of bleeding volume after rupture of anterior cerebral artery aneurysm for prognosis of patients.Methods The data of 40 patients with ruptured anterior cerebral artery aneurysms from January 2016 to December 2022 in Shaanxi Provincial People's Hospital were retrospectively collected.The general clinical data of the patients were sorted out.The patient's plain CT data were imported into 3D Slicer software in DICOM format,and the total bleeding volume of subarachnoid and or ventricular and or intracerebral hematoma was calculated using the software.According to the modified Rankin scale,the patients were divided into poor prognosis groups and good prognosis groups.The prognostic factors were analyzed by binary Logistic regression model.The diagnostic efficacy was analyzed by receiver operating characteristic.The Youden index was calculated to determine the cut-off value of total bleeding volume and prognosis.Results There was no significant difference in gender,age,aneurysm location and surgical method between the two groups(P>0.05).There were significant differences between the two groups in basic diseases,GCS classification,total bleeding volume and bleeding distribution(P<0.05).Multivariate binary Logistic analysis showed that the amount of bleeding was significantly correlated with the prognosis(OR=1.101,95%confidence interval 1.006-1.205;P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve of the binary regression model to distinguish patients with poor prognosis was 0.803(P<0.05),and the cutoff value was about 13.04 ml.Conclusion The total amount of bleeding after rupture of anterior cerebral artery aneurysm is an independent prognostic factor.Total bleeding volume greater than 13.04 ml was associated with an increased risk of poor prognosis.