摘要
目的采用Logistic分析蛛网膜下腔出血(SAH)患者动脉瘤夹闭术后脑水肿发生情况。方法回顾分析于2017-01-2022-06巴中市中心医院收治的113例SAH患者的临床资料,依据行动脉瘤夹闭术后脑水肿发生情况分为脑水肿组(n=41)和未并发脑水肿组(n=72)。统计2组患者一般资料、临床疗效、动脉瘤情况、实验室资料并进行单因素分析,选取其中差异有统计学意义的项目进行Logistic多元逐步回归分析。结果脑水肿组相较于未并发脑水肿组年龄、性别、SBP、DBP、动脉瘤位置、动脉瘤直径、手术时长差异无统计学意义(P>0.05),Hunt-Hess分级、MMP-9[(387.81±80.21)μg/L比(194.41±51.92)μg/L]、VEGF[(398.26±85.60)ng/L比(185.24±55.28)ng/L]更高(P<0.05),GCS得分[(8.45±2.16)分比(12.74±3.15)分]、GOS评分[(3.06±0.79)分比(2.62±0.78)分]得分更低,差异均有统计学意义(P<0.05),2组患者长期(>10 a)吸烟史、入院时瞳孔改变情况差异有统计学意义(P<0.05)。Hunt-Hess分级、GCS得分、长期(>10 a)吸烟史、Fisher分级、是否合并脑积水、是否合并血肿、是否合并严重的脑血管痉挛、术后是否继发出血或梗死、手术时机,MMP-9、VEGF水平为导致术后脑水肿的独立高危因素(P<0.05)。结论Hunt-Hess分级、GCS得分、长期(>10 a)吸烟史、Fisher分级、是否合并脑积水、是否合并血肿、是否合并严重的脑血管痉挛、术后是否继发出血或梗死、手术时机、临床疗效、MMP-9、VEGF水平是导致SAH患者术后脑水肿的独立高危因素,临床应对上述指标及病史等进行评估检测,并加以干预以改善患者预后。
Objective To analyze of cerebral edema in patients with subarachnoid hemorrhage(SAH)after aneurysm clipping using Logistic analysis.Methods The clinical data of 113 patients with SAH who were treated in Bazhong Central Hospital from January 2017 to June 2022 were retrospectively analyzed.With the occurrence of cerebral edema after aneurysm clipping in patients with SAH as grouping basis,the patients were divided into cerebral edema group(n=41)and non-cerebral edema group(n=72).The general data,clinical efficacy,aneurysm condition and laboratory data were collected for univariate analysis of clinical data,and the items with statistical significance were selected for Logistic multivariate stepwise regression analysis.Results There were no statistically significant differences in age,gender,SBP,DBP,aneurysm location,aneurysm diameter,and surgical time in cerebral edema group compared with those in non-cerebral edema group(P>0.05),but the Hunt-Hess grading,MMP-9[(387.81±80.21)μg/L vs(194.41±51.92)μg/L]and VEGF[(398.26±85.60)ng/L vs(185.24±55.28)ng/L]were higher(P<0.05)while the GCS score[(8.45±2.16)points vs(12.74±3.15)points],GOS score[(3.06±0.79)points vs(2.62±0.78)points]was lower(P<0.05).There were statistical differences in the long-term smoking history(>10 years)and pupil changes at admission between the two groups(P<0.05).Hunt-Hess grading,GCS score,long-term smoking history(>10 years),Fisher classification,presence or absence of hydrocephalus,presence or absence of hematoma,presence or absence of severe cerebral vasospasm,presence or absence of postoperative secondary bleeding or infarction,timing of surgery,and levels of MMP-9 and VEGF were independent high-risk factors for postoperative cerebral edema(P<0.05).Conclusion Hunt-Hess grading,GCS score,long-term smoking history(>10 years),Fisher classification,presence or absence of hydrocephalus,presence or absence of hematoma,presence or absence of severe cerebral vasospasm,presence or absence of postoperative secondary bleeding or infarction,timing
作者
桂先正
向仲勋
罗建利
范小春
GUI Xianzheng;XIANG Zhongxun;LUO Jianli;FAN Xiaochun(Bazhong Central Hospital,Bazhong 636000,China;Nanchong Hospital of Traditional Chinese Medicine,Nanchong 637000,China)
出处
《中国实用神经疾病杂志》
2023年第8期968-973,共6页
Chinese Journal of Practical Nervous Diseases
基金
四川省中医药管理局科研课题(编号:2021MS374)。
