早期显微外科手术治疗高分级动脉瘤性蛛网膜下腔出血患者短期预后的影响因素

Prognostic factors for early microsurgical treatment of highly graded aneurysmal subarachnoid haemorrhage

目的分析早期显微外科手术治疗高分级动脉瘤性蛛网膜下腔出血患者短期预后的影响因素。方法回顾分析2019-01—2022-12河南省直第三人民医院的Hunt-Hess分级高级别动脉瘤性蛛网膜下腔出血早期行动脉瘤夹闭术的33例患者临床资料,根据患者术后3个月的mRS评分分为预后良好组17例,预后不良组16例。采用单因素和多因素Logistic回归分析术后3个月预后相关的危险因素。结果单因素分析显示,患者入院时GCS评分(P=0.007)、Hunt-Hess分级(P=0.012)、改良Fisher分级(P=0.024)是早期显微外科手术治疗的高分级动脉瘤性蛛网膜下腔出血患者短期预后的影响因素。多因素Logistic回归分析排除混杂因素后,显示患者入院时Hunt-Hess分级与改良Fisher分级越高,患者出院后3个月的预后越差;入院GCS评分越低,出院后3个月预后越差。结论患者入院GCS评分低、Hunt-Hess分级与改良Fisher分级高是早期显微外科手术治疗高分级动脉瘤性蛛网膜下腔出血患者短期预后不良的独立危险因素。

Objective To analyze the factors influencing the short-term prognosis of patients with high-grade aneurysmal subarachnoid hemorrhage treated by early microsurgery.Methods A retrospective analysis was performed on 33 patients with Hunt-Hess high-grade aneurysmal subarachnoid hemorrhage treated in the Third People’s Hospital of Henan Province from January 2019 to December 2022 who underwent aneurysm clipping at the early stage.According to mRS scores 3 months after discharge,the patients were divided into good prognosis group(17 patients)and poor prognosis group(16 patients).Univariate and multivariate Logistic regression analysis were used to identify the independent risk factors affecting the prognosis 3 months after discharge.Results Univariate analysis showed that GCS score at admission(P=0.007),Hunt-Hess grade(P=0.012)and modified Fisher grade(P=0.024)were risk factors for short-term prognosis in early microsurgery for high-grade aneurysmal subarachnoid hemorrhage.Multivariate Logistic regression analysis excluding confounding factors showed that the higher of the grade of Hunt-Hess grade and modified Fisher grade at admission,the worse of the prognosis 3 months after discharge.The lower of the GCS score on admission,the worse of the prognosis 3 months after discharge.Conclusion The lower GCS score the admission,and the higher Hunt-Hess grade and Nervous Diseases Jun.2024,Vol.27 No.6 modified Fisher grade are independent risk factors for poor short-term prognosis in patients with high-grade aneurysmal subarachnoid hemorrhage treated by early microsurgery.