本文選題：動脈瘤　切入點：蛛網(wǎng)膜下腔出血　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:動脈瘤性蛛網(wǎng)膜下腔出血(aSAH)是一種高發(fā)病率和高死亡率的急性腦血管疾病。發(fā)病后的神經(jīng)功能缺失與aSAH的出血量是存在顯著相關(guān)性的,我們一般使用改良fisher分級來衡量aSAH出血量的多少。在動脈瘤性蛛網(wǎng)膜下腔出血病例中,發(fā)病后死亡率及病殘率與出血量存在相關(guān)性,探尋aSAH后出血量與疾病的死殘率之間的關(guān)系,從社會公共健康的角度來說研究決定aSAH出血量的風(fēng)險因素是十分重要的。方法:本研究選取了155個aSAH患者來研究可能導(dǎo)致aSAH出血量增加的相關(guān)危險因素,其中包括:人口統(tǒng)計學(xué)因素,既往病史,院前血壓水平和動脈瘤的特征。我們對入組的患者進行分析研究并如實記錄了以下的相關(guān)數(shù)據(jù):1易感的危險因素諸如性別,年齡,吸煙,高血壓及糖尿病;2院前血壓水平(特制患者在動脈瘤破裂之后,在使用口服或者靜脈降壓藥物治療之前的血壓水平),包括院前的收縮、舒張壓和脈壓;3破裂動脈的相關(guān)特征,包括動脈瘤的形態(tài),大小,位置(細(xì)分為頸內(nèi)動脈動脈瘤,前交通動脈動脈瘤,大腦中動脈動脈瘤,大腦后動脈動脈瘤,大腦前動脈動脈瘤,基底動脈動脈瘤,小腦后下動脈動脈瘤,小腦前下動脈動脈瘤,椎動脈動脈瘤),動脈瘤的總數(shù)目(單一患者),動脈瘤體的最大直徑,動脈瘤頸的直徑及動脈瘤體頸比。我們選取了性別,年齡,高血壓,糖尿病,吸煙,院前血壓的收縮壓,院前血壓的舒張壓,院前血壓的脈壓,動脈瘤的形態(tài),數(shù)目,位置,瘤體最大直徑,瘤頸最大直徑,體頸比作為分別獨立的自變量。用改良fisher分級水平作為因變量。使用SAS9.2統(tǒng)計軟件進行統(tǒng)計分析。結(jié)果:對危險因素的單因素分析結(jié)果1單個患者顱內(nèi)動脈瘤的數(shù)目與發(fā)病后改良fisher分級有重要的關(guān)系(grade 3-4;P=0.016)。顱內(nèi)多發(fā)動脈瘤(2-4個)是可能導(dǎo)致較高的改良fisher分級的重要原因([OR]=4.0,P=0.004)。2位于頸內(nèi)動脈、前交通動脈及大腦中動脈的動脈瘤相對于其他部位動脈瘤是導(dǎo)致較高的改良fisher分級的重要危險因子(P0.001)。前交通動脈動脈瘤破裂出血與較高的改良Fisher分級存在重要的相關(guān)性(OR=4.3,P=0.025)。3患者院前血壓的舒張壓(DBP)較高是可能導(dǎo)致發(fā)病后較高的改良Fisher分級的危險因素(P=0.024)。對危險因素的多因素分析結(jié)果1研究發(fā)現(xiàn)前交通動脈瘤動脈瘤破裂出血與更高的改良fisher分級存在重要的相關(guān)性([OR]=4.3,P=0.025),頸內(nèi)動脈動脈瘤破裂出血與發(fā)病后改良fisher分級0-2級關(guān)系是成反比的(OR=0.6,P0.001))。2患者患有多個動脈瘤(2-4)是發(fā)病后造成更高的改良fisher分級的重要危險因素(OR=4.0,P=0.004)。相反的,單發(fā)大腦中動脈動脈瘤破裂出血,在對于造成更高的改良fisher分級沒有統(tǒng)計學(xué)意義(OR=4.1)。3盡管較高的院前舒張壓水平與與發(fā)病后更高的改良fisher分級存在重要的相關(guān)性(P=0.047),但這并不能作為獨立的臨床相關(guān)危險因素(OR=1.0)。結(jié)論:院前血壓的舒張壓(DBP),顱內(nèi)多發(fā)動脈瘤和前交通動脈動脈瘤與蛛網(wǎng)膜下腔出血出發(fā)病后血量較多存在明顯的相關(guān)性。具有以上特征的動脈瘤患者應(yīng)該給予早期干預(yù)和治療以預(yù)防相關(guān)危險的發(fā)生。
[Abstract]:Objective: aneurysmal subarachnoid hemorrhage (aSAH) is a kind of high incidence and high mortality of acute cerebral vascular disease. The amount of bleeding and loss of nerve function after the onset of aSAH is significant correlation, we generally use the modified Fisher grade aSAH to measure the amount of bleeding in aneurysmal subarachnoid space. After the onset of subarachnoid hemorrhage cases, the mortality rate and disability rate and the amount of bleeding are correlated to explore the relationship between the aSAH and the amount of bleeding disease the rate of death and disability, from the public health perspective on the decision risk factors for aSAH hemorrhage is very important. Methods: This study selected 155 aSAH patients to study may lead to increased risk factors, aSAH hemorrhage including: demographic factors, medical history, characteristics of the level of blood pressure and artery aneurysm before hospital. We enrolled patients as research and analysis The real record of the relevant data of the following: 1 susceptible risk factors such as gender, age, smoking, hypertension and diabetes; 2 pre hospital blood pressure level (after rupture of aneurysm in special patients before using oral or intravenous antihypertensive treatment, blood pressure levels) including pre hospital contraction, diastolic pressure and pulse pressure; 3 characteristics of artery rupture, including aneurysm morphology, size, location (subdivided into internal carotid artery aneurysm, aneurysm of anterior communicating artery, middle cerebral artery aneurysms and aneurysms of the posterior cerebral artery, anterior cerebral artery aneurysm, basilar artery aneurysms and aneurysms of the posterior inferior cerebellar artery, anterior inferior cerebellar artery aneurysm of vertebral artery aneurysm), the total number of aneurysms (single patients), the maximum diameter of the aneurysm, the aneurysm diameter and carotid artery aneurysm neck ratio. We selected the gender, age, hypertension, diabetes, smoking, blood pressure before the hospital The systolic pressure, diastolic blood pressure and pre hospital, hospital blood pressure pulse pressure, arterial aneurysm morphology, number, location, tumor diameter, the largest diameter of aneurysm neck, neck and body respectively than as independent variable. Using the modified Fisher grade level as the dependent variable. The statistical analysis was performed using SAS9.2 statistical software. Results: the single factor analysis on risk factors of the number 1 single intracranial artery tumor patients with the onset of the modified Fisher grading has an important relationship (grade 3-4; P=0.016). Multiple intracranial aneurysms (2-4) may be important factors leading to higher grade of the modified Fisher ([OR]=4.0, P=0.004).2 is located in the internal carotid artery, artery aneurysms of the anterior communicating artery and middle cerebral artery aneurysms compared to other parts is an important risk factor which lead to improved Fisher high grade (P0.001). The anterior communicating artery aneurysm rupture and modified Fisher grade high significant Correlation (OR=4.3, P=0.025).3 in patients with diastolic blood pressure (DBP) is high may lead to the danger of modified Fisher high grade factors after onset (P=0.024). Multiple factor analysis on the risk factors of the study found that 1 aneurysms of anterior communicating artery aneurysm rupture and modified Fisher grade higher significant correlation ([OR]=4.3, P=0.025), internal carotid artery aneurysm rupture and bleeding after the onset of the modified Fisher grade 0-2 level is inversely proportional to the relationship (OR=0.6, P0.001).2) in patients with multiple intracranial aneurysms (2-4) is an important risk caused by the modified Fisher grade higher after the onset of the factors (OR=4.0, P=0.004) instead. Solitary, ruptured middle cerebral artery aneurysms, there was no statistical significance in the modified Fisher grade for the cause of higher.3 (OR=4.1) despite the higher pre hospital diastolic blood pressure level and the modified Fisher grade after the onset and higher being important The correlation (P=0.047), but this is not an independent clinical risk factors (OR=1.0). Conclusion: the diastolic blood pressure (DBP), and multiple intracranial aneurysms of anterior communicating artery aneurysms with subarachnoid hemorrhage volume there are more obvious correlation of aneurysm patients after onset. With the above characteristics should be given early intervention and treatment to prevent the occurrence of the risk.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.35

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