本文選題：動(dòng)脈瘤性蛛網(wǎng)膜下腔出血 + 腦積水　； 參考：《浙江大學(xué)》2014年碩士論文

【摘要】：目的分析動(dòng)脈瘤性蛛網(wǎng)膜下腔出血(aSAH)后慢性腦積水形成的危險(xiǎn)因素,并進(jìn)一步探討危險(xiǎn)因素對(duì)慢性腦積水患者行腦室-腹腔分流術(shù)(VPS)預(yù)后的影響,旨在病因?qū)W和治療學(xué)兩方面上提高患者的整體預(yù)后。 方法回顧性收集2009年6月至2012年6月間我院收治的202例aSAH病人臨床病例資料,根據(jù)有無(wú)慢性腦積水分為腦積水組與無(wú)腦積水組；對(duì)腦積水組行VPS患者隨訪6個(gè)月至2年,根據(jù)隨訪結(jié)果分為有效組與無(wú)效組。利用單因素分析方法(卡方檢驗(yàn)、秩和檢驗(yàn)、Fisher精確檢驗(yàn)等)及多因素分析方法(Logistic回歸法)對(duì)危險(xiǎn)因素和預(yù)后因素進(jìn)行對(duì)比分析。 結(jié)果aSAH后慢性腦積水的發(fā)生率為27.2%(55/202)。單因素分析中,年齡、高血壓、格拉斯哥評(píng)分(GCS)、 Hunt-Hess分級(jí)、Fisher分級(jí)、動(dòng)脈瘤位置、出血次數(shù)、急性腦積水、血腫位置、腦室外引流(EVD)及引流時(shí)間、手術(shù)方式、去骨瓣減壓術(shù)(DC)、腦血管痙攣和顱內(nèi)感染(ICI)具有統(tǒng)計(jì)學(xué)意義(P0.05)；多因素分析顯示高齡、高血壓史、后循環(huán)動(dòng)脈瘤、急性腦積水、腦室內(nèi)血腫(IVH)、VD及EVD時(shí)間是獨(dú)立危險(xiǎn)因素。40例行VPS慢性腦積水患者完成隨訪,26例術(shù)后病情好轉(zhuǎn)(65%)；年齡、GCS、Hunt-Hess分級(jí)、EVD時(shí)間、ICI對(duì)VPS預(yù)后有顯著性影響。 結(jié)論aSAH后慢性腦積水的形成與多重因素相關(guān),其中高齡、入院時(shí)腦神經(jīng)功能較差、EVD及EVD時(shí)間較長(zhǎng)、ICI等不僅可提示易形成慢性腦積水,同時(shí)還可預(yù)測(cè)VPS的預(yù)后。對(duì)具備上述因素的aSAH患者給予及時(shí)適當(dāng)?shù)奶幚?可改善該部分病人的整體預(yù)后。
[Abstract]:Objective to analyze the risk factors of chronic hydrocephalus after aneurysm subarachnoid hemorrhage (SAH) and to explore the influence of risk factors on the prognosis of VPS in patients with chronic hydrocephalus. The aim is to improve the overall prognosis of patients both in etiology and therapeutics. Methods the clinical data of 202 patients with aSAH from June 2009 to June 2012 were retrospectively collected and divided into hydrocephalus group and non-hydrocephalus group according to chronic hydrocephalus, followed up for 6 months to 2 years in hydrocephalus group. According to the results of follow-up, they were divided into effective group and ineffective group. Single factor analysis (chi-square test, rank sum test, Fisher accurate test) and multivariate analysis method (logistic regression) were used to compare the risk factors and prognostic factors. Results the incidence of chronic hydrocephalus after aSAH was 27.2%. In univariate analysis, age, hypertension, Glasgow scale, Hunt-Hess grade, aneurysm location, bleeding times, acute hydrocephalus, hematoma location, ventricular drainage time, operative method, and so on. DCI, cerebral vasospasm and intracranial infection (ICI) had statistical significance (P 0.05). Multivariate analysis showed that age, history of hypertension, posterior circulatory aneurysm, acute hydrocephalus were found in the elderly, the history of hypertension, the posterior circulation aneurysm, and the acute hydrocephalus. VD and EVD time were independent risk factors in intraventricular hematoma. Forty patients with VPS chronic hydrocephalus were followed up and 26 patients with chronic hydrocephalus were followed up. Conclusion the formation of chronic hydrocephalus after aSAH is related to many factors. Among them, the elderly, the poor cerebral neurologic function and the longer EVD time can not only indicate the formation of chronic hydrocephalus, but also predict the prognosis of VPS. Timely and appropriate treatment of aSAH patients with these factors can improve the overall prognosis of these patients.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.34

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相關(guān)期刊論文 前3條

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本文編號(hào)：1883303