动脉瘤性蛛网膜下腔出血介入栓塞术后并发脑积水的危险因素分析

Risk factors analysis of hydrocephalus after interventional thrombectomy for aneurysmal subarachnoid hemorrhage

目的分析动脉瘤性蛛网膜下腔出血(SAH)实施介入栓塞术后并发脑积水的危险因素。方法本研究为回顾性病例对照研究,选取2022年6月至2023年6月南阳医学高等专科学校第一附属医院神经内科收治的接受介入栓塞术治疗的106例动脉瘤性SAH患者,男56例,女50例,年龄(60.33±5.18)岁,年龄范围为42~78岁。比较术后并发脑积水患者及未并发脑积水患者的一般资料及临床资料,采用单因素及多因素logistic回归模型分析并发脑积水的危险因素。结果动脉瘤性SAH术后,并发脑积水患者46例,未并发脑积水患者60例。单因素分析结果显示,并发脑积水患者的年龄≥60岁[65.2%(30/46)]、合并高血压[50.0%(23/46)]、动脉瘤最大径≥5 mm[60.9%(28/46)]、入院时GCS评分≤8分[67.4%(31/46)]、动脉瘤位于椎基底动脉系统[69.6%(32/46)]、Hunt-hess分级为Ⅲ~Ⅴ级[84.8%(39/46)]、术后合并ICH[41.3%(19/46)]、术后合并脑室出血[43.5%(20/46)]、采用脑室外引流[67.4%(31/46)]占比均高于未并发脑积水患者[46.7%(28/60)、28.3%(17/60)、41.7%(25/60)、36.7%(22/60)、48.3%(29/60)、50.0%(30/60)、33.3%(20/60)、25.0%(15/60)、21.7%(13/60)、43.3%(26/60)],差异有统计学意义(P<0.05)。logistic多因素回归分析结果显示,年龄≥60岁(OR=3.363,95%CI:1.339~8.414)、合并高血压(OR=3.803,95%CI:1.614~8.669)、动脉瘤位于颈内动脉系统(OR=1.938,95%CI:1.326~7.661)、Hunt-hess为Ⅲ~Ⅴ级(OR=4.874,95%CI:1.288~8.617)、合并ICH(OR=9.801,95%CI:1.233~9.916)、合并脑室出血(OR=2.806,95%CI:1.252~8.931)、采用脑室外或腰大池引流(OR=5.807,95%CI:1.331~9.445)为导致患者术后并发脑积水的独立危险因素(P<0.05)。结论年龄≥60岁、合并高血压、动脉瘤位于椎基底动脉系统、Hunt-hess为Ⅲ~Ⅴ级、合并ICH、合并脑室出血、采用脑室外引流为导致患者术后并发脑积水的独立危险因素。

Objective Analyze the risk factors of hydrocephalus after interventional thrombectomy for arterial subarachnoid hemorrhage(SAH).Methods This study was a retrospective case-control study,a total of 106 patients with aneurysmal SAH who underwent interventional embolization treatment were selected from the department of Neurology in the First Affiliated Hospital of Nanyang Medical College from June 2022 to June 2023,aged(60.33±5.18)years old,ranging form 42 to 78 years old.Compare the general and clinical data of postoperative patients with and without concurrent hydrocephalus,and use univariate and multivariate logistic regression models to analyze the risk factors for concurrent hydrocephalus.Results There were 46 cases complicated with hydrocephalus and 60 cases without hydrocephalus after aneurysmal SAH.The results of univariate analysis showed that the postoperative patients with concurrent hydrocephalus had an age of≥60 years old[65.2%(30/46)],concomitant hypertension[50.0%(23/46)],aneurysm maximum diameter≥5 mm[60.9%(28/46)],Glasgow coma scale(GCS)score≤8 points at admission[67.4%(31/46)],aneurysm located in the vertebrobasilar artery system[69.6%(32/46)],aneurysm Hunt less gradeⅢtoⅤ[84.8%(39/46)],preoperative cerebral hemorrhage range>30%[52.2%(24/46)],after surgery concomitant intracerebral hemorrhage[ICH,41.3%(19/46)],after surgery concomitant of intraventricular hemorrhage[43.5%(20/46)],using extraventricular or lumbar cistern drainage[67.4%(31/46)]with a higher proportion than the postoperative patients without concurrent hydrocephalus[46.7%(28/60),28.3%(17/60),41.7%(25/60),36.7%(22/60),48.3%(29/60),50.0%(30/60),33.3%(20/60),25.0%(15/60),21.7%(13/60),43.3%(26/60)],the differences were statistically significant(P<0.05).The results of logistic multiple regression analysis showed that age≥60 years old(OR=3.363,95%CI:1.339 to 8.414),concomitant hypertension(OR=3.803,95%CI:1.614 to 8.669),aneurysm located in the internal carotid artery system(OR=1.938,95%CI:1.326 to 7.661),Hunt-ness gradeⅢtoⅤ(OR=4.874,95%CI:1.288 to 8.617),after surgery concomitant ICH(OR=9.801,95%CI:1.233 to 9.916),after surgery concomitant of intraventricular hemorrhage(OR=2.806,95%CI:1.252 to 8.931),using extraventricular or lumbar cistern drainage(OR=5.807,95%CI:1.331 to 9.445)were independent risk factors for postoperative hydrocephalus in patients(P<0.05).Conclusions Age≥60 years old,concomitant hypertension,aneurysm located in the internal carotid artery system,Hunt-ness gradeⅢtoⅤ,after surgery concomitant ICH,after surgery concomitant of intraventricular hemorrhage,using extraventricular or lumbar cistern drainage were independent risk factors for postoperative hydrocephalus in patients.