高Hunt-Hess分级动脉瘤性蛛网膜下腔出血导致慢性意识障碍的影响因素分析

Analysis of factors influencing prolonged disorder of consciousness caused by high Hunt-Hess grade aneurysmal subarachnoid hemorrhage

目的探讨高Hunt-Hess分级动脉瘤性蛛网膜下腔出血(aSAH)患者出现慢性意识障碍(pDoC)的影响因素。方法采集2018年5月至2022年4月在邯郸市中心医院治疗的88例高Hunt-Hess分级aSAH患者的术前临床资料。治疗后28 d开始参照昏迷恢复量表-修订版(CRS-R)评估意识状态,每半个月评估1次,共评估6次,根据最高分数的量表评估结果将患者意识状态分为pDoC组和非pDoC组。多因素Logistic回归分析高Hunt-Hess分级a SAH患者治疗后发生pDoC的影响因素。利用ROC曲线分析预测pDoC的效能。结果pDoC组与非pDoC组患者术前是否出现颅内血肿、破入脑室、急性脑积水、血糖水平、血糖/血钾比值、白细胞计数比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示颅内血肿、急性脑积水、血糖水平、白细胞计数与高分级aSAH治疗后是否发生pDoC有关(OR=2.373、5.984、1.420、1.179,P<0.05)。ROC曲线分析结果提示,血糖、白细胞计数、颅内血肿和急性脑积水预测发生pDoC的AUC分别为0.755(95%CI=0.647~0.864)、0.706(95%CI=0.590~0.821)、0.763(95%CI=0.658~0.869)、0.708(95%CI=0.593~0.822)。血糖、白细胞计数约登指数为0.446、0.353;敏感度为82.14%、71.43%;特异度为65.63%、62.50%。血糖、白细胞计数最佳截断值分别为13.25 mmol/L、19.65×10~9/L。结论发生颅内血肿和急性脑积水以及术前血糖和白细胞计数是高Hunt-Hess分级aSAH患者pDoC发生的影响因素,这些指标对高Hunt-Hess分级aSAH患者治疗后发生pDoC具有较高的预测价值。

Objective To investigate the influencing factors contributing to the occurrence of prolonged disorders of consciousness(pDoC)in patients with high Hunt-Hess grade aneurysmal subarachnoid hemorrhage(aSAH).Methods Preoperative clinical data of 88 patients with high Hunt-Hess grade aSAH treated at Handan Central Hospital from May 2018 to April 2022 were collected.Consciousness status was evaluated using the Coma Recovery Scale Revised Version(CRS-R)starting at 28 days after treatment,with assessments conducted every half month for a total of 6 times.Patients were divided into pDoC group and non-pDoC group based on the highest score obtained from the scale.Influencing factors for the occurrence of pDoC after treatment in patients with high Hunt-Hess grade aSAH were analyzed by multivariate Logistic regression.The efficacy of predicting pDoC was analyzed using ROC curve.Results Significant differences were observed between the pDoC group and the non-pDoC group in terms of preoperative intracranial hematoma,intraventricular rupture,acute hydrocephalus,blood glucose,blood glucose/potassium ratio,and white blood cell count(P<0.05).Multivariate Logistic regression analysis showed that intracranial hematoma,acute hydrocephalus,blood glucose,and white blood cell count were associated with the occurrence of pDoC after treatment for high-grade aSAH(OR=2.373,5.984,1.420,1.179;P<0.05).ROC curve analysis suggested that AUCs of blood glucose,white blood cell count,intracranial hematoma,and acute hydrocephalus for predicting the occurrence of pDoC were 0.755(95%CI=0.647-0.864),0.706(95%CI=0.590-0.821),0.763(95%CI=0.658-0.869),and 0.708(95%CI=0.593-0.822),respectively.The Yoden index for blood glucose and white blood cell count were 0.446 and 0.353,respectively,with sensitivity of 82.14%and 71.43%,and specificity of 65.63%and 62.50%.The optimal cut-off values for blood glucose and white blood cell count were 13.25 mmol/L and 19.65×109/L,respectively.Conclusion Intracranial hematoma,acute hydrocephalus,preoperative blood glucose and white blood cell count are influencing factors for the occurence of pDoC in patients with high Hunt-Hess grade aSAH,providing significant predictive value for pDoC after treatment in these patients.