标题：动脉瘤性蛛网膜下腔出血患者术后发生延迟性脑缺血的相关因素及对预后的影响

      作者：巨涛，刘增强，亓乾伟，岳新鹏，王鑫超，宋波    延安大学咸阳医院神经外科，陕西 咸阳 712000

      卷次： 2022年33卷10期

      【摘要】 目的 探究动脉瘤性蛛网膜下腔出血(aSAH)患者动脉瘤夹闭术后发生延迟性脑缺血的相关因素及对预后的影响。方法 回顾性分析 2018年 5月至 2021年 1月在延安大学咸阳医院行动脉瘤夹闭术治疗的 53例aSAH患者的临床资料，根据延迟性脑缺血发生情况将患者分为脑缺血组15例和正常组(未出现延迟性脑缺血者)38例，采用多元Logistic回归、受试者工作特征曲线(ROC)分别分析影响延迟性脑缺血发生的危险因素及各危险因素对延迟性脑缺血发生的预测价值；根据术后28 d格拉斯哥预后评分(GOS)对患者预后进行评价，比较脑缺血组及正常组的预后，采用比例风险回归模型(Cox)分析术后延迟性脑缺血与预后的关系。结果 脑缺血组患者在Hunt-Hess分级4~5级、患糖尿病、脑血管痉挛、动脉瘤大小>2.5 cm方面的人数比例明显高于正常组，差异均有统计学意义(P<0.05)；经多元Logistic回归分析结果显示，Hunt-Hess分级4~5级、患糖尿病、脑血管痉挛是 aSAH患者发生延迟性脑缺血的危险因素(P<0.05)；经ROC曲线分析显示，Hunt-Hess分级、糖尿病、脑血管痉挛预测延迟性脑缺血发生的曲线下面积(AUC)分别为0.674、0.705、0.679；脑缺血组的预后不良发生率为 86.67%，明显高于正常组的23.68%，差异有统计学意义(P<0.05)；经多元Logistic回归分析结果显示，发生延迟性脑缺血是影响患者预后的危险因素(P<0.05)。结论 aSAH患者动脉瘤夹闭术后延迟性脑缺血发生率较高，Hunt-Hess分级4~5级、患糖尿病、脑血管痉挛是aSAH患者发生延迟性脑缺血的危险因素，且发生延迟性脑缺血可影响患者预后。
      【关键词】 动脉瘤性蛛网膜下腔出血；动脉瘤夹闭术；延迟性脑缺血；危险因素；预后
      【中图分类号】 R743.31 【文献标识码】 A 【文章编号】 1003—6350（2022）10—1255—04

Related factors of postoperative delayed cerebral ischemia and its influences on prognosis of patients withaneurysmal subarachnoid hemorrhage.
JU Tao, LIU Zeng-qiang, QI Qian-wei, YUE Xin-peng, WANG Xin-chao,SONG Bo. Department of Neurosurgery, Xianyang Hospital of Yan'an University, Xianyang 712000, Shaanxi, CHINA
【Abstract】 Objective To explore the related factors of delayed cerebral ischemia and its influences on progno-sis of patients with aneurysmal subarachnoid hemorrhage (aSAH) after aneurysm clipping. Methods A retrospectiveanalysis was performed on the clinical data of 53 patients with aSAH undergoing aneurysm clipping in Xianyang Hospi-tal of Yan'an University between May 2018 and January 2021. According to presence or absence of delayed cerebral isch-emia, they were divided into cerebral ischemia group (15 cases) and normal group (38 cases). The risk factors of delayedcerebral ischemia and their predictive value for delayed cerebral ischemia were analyzed by multivariate logistic regres-sion analysis and receiver operating characteristic curves (ROC curves), respectively. The prognosis of patients was eval-uated according to scores of Glasgow Outcome Scale (GOS) at 28 d after surgery. And the prognosis between cerebralischemia group and normal group was compared. The relationship between delayed cerebral ischemia and prognosis wasanalyzed by proportional hazards regression model (Cox). Results The proportions of cases with Hunt-Hess grading atgrades 4-5, diabetes, cerebral vasospasm, and aneurysm>2.5 cm in cerebral ischemia group were significantly higherthan those in normal group (P<0.05). The results of multivariate logistic regression analysis showed that Hunt-Hess grad-ing at grades 4-5, diabetes and cerebral vasospasm were risk factors of delayed cerebral ischemia in aSAH patients (P<0.05). ROC curves analysis showed that area under the curve (AUC) values of Hunt-Hess grading, diabetes, and cerebralvasospasm for predicting delayed cerebral ischemia were 0.674, 0.705, and 0.679, respectively. The incidence of poorprognosis in cerebral ischemia group was 86.67% (13/15), significantly higher than 23.68% (9/38) in normal group (P<0.001). Multivariate Logistic regression analysis showed that delayed cerebral ischemia was a risk factor of prognosis(P<0.05). Conclusion The incidence of delayed cerebral ischemia in aSAH patients after aneurysm clipping is relative-ly high. Hunt-Hess grading at grades 4-5, diabetes, and cerebral vasospasm are risk factors of delayed cerebral ischemia.Delayed cerebral ischemia can affect the prognosis of patients.
      【Key words】 Aneurysmal subarachnoid hemorrhage; Aneurysm clipping; Delayed cerebral ischemia; Risk factor;Prognosis