摘要
目的分析破裂动脉瘤性蛛网膜下腔出血(aSAH)手术夹闭后脑水肿发生和患者预后的影响因素。方法选择2017年1月至2020年12月在商丘市长征人民医院神经外科接受治疗的aSAH患者207例的临床数据资料进行回顾性分析。aSAH手术夹闭后患者脑水肿出现的单因素分析、多因素分析。aSAH手术夹闭后发生脑水肿患者的短期预后情况。aSAH手术夹闭后发生脑水肿患者预后的影响因素分析。结果全部纳入研究的患者之中,有91例在术后发生了脑水肿,有116例术后未发生脑水肿,aSAH手术夹闭后脑水肿的发生率为43.96%。发生术后脑水肿的患者的入院时的收缩压、Hunt-Hess分级、Fisher分级、手术时间长度、去骨瓣的使用比例、术前脑静脉充盈缺损现象的出现比例均高于未发生术后脑水肿的患者,差异有统计学意义(P<0.05)。入院时的收缩压较高(OR=1.028)、Fisher分级≥Ⅲ级(OR=1.587,1.676)、手术时间长度较长(OR=1.008)、手术使用去骨瓣的操作(OR=10.569)、术前出现脑静脉充盈缺损现象(OR=43.772)的患者出现术后脑水肿的风险更高差异,差异有统计学意义(P<0.05)。91名aSAH手术夹闭后发生脑水肿患者术后14 d的改良c评分平均为(2.93±1.12)分。在aSAH手术夹闭后发生脑水肿患者人群中,男性(β’=0.308)、Fisher分级较高(β’=0.642)、具有术前脑静脉充盈缺损现象(β’=0.567)的患者预后更差,差异有统计学意义(P<0.05)。结论脑水肿对于aSAH手术夹闭后患者的预后具有重要的意义,部分因素对于患者在该类手术后发生脑水肿以及预后可以产生影响,临床上需要对这些因素给予充分的重视。
Objective To analyze the factors influencing the occurrence of brain edema and patient prognosis after surgical clipping of ruptured aneurysm(aSAH).Methods The clinical data of 207 patients with aSAH who were treated in Shangqiu Changzheng People's Hospital between January 2017 and December 2020 were retrospectively analyzed.Short term prognosis of patients with cerebral edema after surgical clipping of aSAH.Analysis of influencing factors on the prognosis of patients with cerebral edema after surgical clipping of aSAH.Results Among all patients included in the study,91 experienced postoperative brain edema,while 116 did not.The incidence of brain edema after aSAH surgery was 43.96%.Patients with postoperative brain edema had higher systolic blood pressure at admission,Hunt Hess grading,Fisher grading,surgical duration,proportion of bone flap removal,and incidence of preoperative cerebral venous filling defects compared to patients without postoperative brain edema,the difference was statistically significant(P<0.05).Patients with high systolic blood pressure at admission(OR=1.028),Fisher grade≥Ⅲ(OR=1.587,1.676),longer surgical time(OR=1.008),surgical use of bone flap removal(OR=10.569),and preoperative occurrence of cerebral venous filling defects(OR=43.772)have a higher risk of postoperative brain edema,the difference was statistically significant(P<0.05).The average modified C score of 91 patients with cerebral edema after surgical clipping of aSAH on the 14th day after surgery was(2.93±1.12)points.In the population of patients with cerebral edema after aSAH surgical clipping,males(β'=0.308),Fisher has a higher rating(β'=0.642).Preoperative cerebral venous filling defect(β'=Patients with 0.567 had a worse prognosis,the difference was statistically significant(P<0.05).Conclusion Brain edema is of great significance for the prognosis of patients after aSAH surgery,and some factors can have an impact on the occurrence and prognosis of brain edema in patients after such surgery.In clinical practice,suffici
作者
朱伟
ZHU Wei(Neurosurgery,Shangqiu Changzheng People's Hospital,Shangqiu Henan 476002,China)
出处
《临床研究》
2023年第7期4-8,共5页
Clinical Research
关键词
动脉瘤
脑水肿
预后
蛛网膜下腔
肛提肌裂孔
脑静脉充盈
aneurysm
brain edema
prognosis
subarachnoid space
levator ani hiatus
cerebral venous filling
