摘要
目的分析动脉瘤性蛛网膜下腔出血介入栓塞术后发生分流依赖性脑积水(shunt-dependent hydrocephalus,SDH)的影响因素,为降低分流依赖性脑积水的发生率及改善预后提供临床经验及依据。方法选取2014年1月至2019年12月南方医科大学附属小榄医院收治的104例行脑脊液引流的动脉瘤性蛛网膜下腔出血患者,按照“并发SDH与否”的标准分为两组,即SDH组(并发SDH,15例)和非SDH组(未并发SDH,89例),对两组病例的相关临床资料进行单因素分析,再将统计学差异的结果纳入多因素Logistic回归分析,以探讨并发SDH的危险因素。结果单因素分析结果显示,术前Fisher分级、术前脑室积血、术前Hunt-Hess分级、术前再出血、术后颅内感染、急性脑积水脑脊液引流方式在SDH组、非SDH组之间差异有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,脑室积血(OR=2.738,95%CI:1.249~5.803)、Hunt-Hess分级Ⅲ~V级(OR=6.034,95%CI:3.243~28.663)、再出血(OR=7.582,95%CI:4.503~49.431)、急性脑积水脑脊液引流方式为脑室外引流术(OR=3.828,95%CI:3.198~13.697)是SDH发生的危险因素(P<0.05)。结论SDH是动脉瘤性蛛网膜下腔出血介入栓塞术后常见的严重并发症,其危险因素包括脑室积血、Hunt-Hess分级、再出血、急性脑积水脑脊液引流方式。临床应该为上述术后患者进行脑积水高危因素评估,积极采取措施预防脑积水的发生。
Objective To analyze the influencing factors of shunt-dependent hydrocephalus(SDH)after interventional embolization of aneurysmal subarachnoid hemorrhage,and to provide clinical evidence experience and for reducing the incidence of shunt-dependent hydrocephalus and improving prognosis.Methods A total of 104 patients with aneurysmal subarachnoid hemorrhage who underwent cerebrospinal fluid drainage were selected from the Xiaolan Hospital Affiliated to Southern Medical University during January 2014 to December 2019.All patients were divided into 2 groups according to the criteria of"concurrent SDH or not",namely the SDH group(with SDH,a total of 15 cases)and the non-SDH group(without SDH,a total of 89 cases),and univariate analysis on the relevant clinical data of the two groups was done.The results with significant differences were included in the multivariate Logistic regression analysis which to explore the risk factors of concurrent SDH.Results Univariate analysis showed that preoperative Fisher classification,preoperative intraventricular hemorrhage,preoperative Hunt-Hess classification,preoperative rebleeding,postoperative intracranial infection,cerebrospinal fluid extraventricular drainage for treating acute hydrocephalus were significant differenes between the SDH group and non-SDH group(all P<0.05).The results of multivariate Logistic regression analysis showed that intraventricular hemorrhage(OR=2.738,95%CI:1.249~5.803),Hunt-Hess gradeⅢ~Ⅴ(OR=6.034,95%CI:3.243~28.663),rebleeding(OR=7.582,95%CI:4.503~49.431),and the mode of cerebrospinal fluid drainage in acute hydrocephalus(OR=3.828,95%CI:3.198~13.697)were the risk factors the occurrence of SDH(P<0.05).Conclusion SDH is a common serious complication after interventional embolization for aneurysmal subarachnoid hemorrhage,and its risk factors include hemoventricular hemorrhage,Hunt-Hess classification,rebleeding,and CSF drainage for acute hydrocephalus.Clinically,patients should be evaluated for high-risk factors of hydrocephalus,and measures should be taken to prevent the occurrence of hydrocephalus.
作者
张明文
于志虎
何咏超
林其炎
张晓峰
孙异春
ZHANG Mingwen;YU Zhihu;HE Yongchao;LIN Qiyan;ZHANG Xiaofeng;SUN Yichun(Department of neurosurgery,Affiliated Xiaolan Hospital,Southern Medical University,Zhongshan,Guangdong 528415,China)
出处
《大医生》
2022年第20期5-9,共5页
Doctor
基金
中山市社会公益科技研究项目(编号:2018B1073)。
