本文選題：動脈瘤 + 蛛網(wǎng)膜下腔出血　； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過回顧性病例分析,篩選出與遲發(fā)性缺血性神經(jīng)功能障礙(delayed ischemic neurological deficit,DIND)發(fā)生顯著相關(guān)的危險(xiǎn)因素,并及時(shí)的采取措施進(jìn)行干預(yù),以期提高動脈瘤性蛛網(wǎng)膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)的治療效果及改善患者的預(yù)后。方法:收集山西醫(yī)科大學(xué)附屬大醫(yī)院神經(jīng)外科2014年3月至2016年9月收住院治療的127例aSAH患者的臨床資料及隨訪結(jié)果�；仡櫺苑治龌颊叩哪挲g、性別、吸煙史、腦血管痙攣情況、入院時(shí)血壓、心電圖、白細(xì)胞計(jì)數(shù)、血漿D-二聚體、動脈瘤位置、GCS評分、臨床分級、Fisher分級等18項(xiàng)相關(guān)因素,并隨訪3個(gè)月,按照GOS評分評估預(yù)后。根據(jù)是否發(fā)生DIND分組,分為DIND組和非DIND組,采用SPSS22.0統(tǒng)計(jì)軟件,分別對上述因素進(jìn)行統(tǒng)計(jì)描述和影響因素分析,最終確定其發(fā)生的危險(xiǎn)因素。結(jié)果:127例患者中發(fā)生遲發(fā)性缺血性神經(jīng)功能障礙的共30例,占23.6%,其中男15例,女15例,男女比例1:1,年齡最小的35歲,最大年齡78歲,平均年齡(53.47±10.76)歲。單因素分析結(jié)果顯示吸煙史、腦血管痙攣情況、心電圖、GCS評分、臨床分級及Fisher分級差異具有統(tǒng)計(jì)學(xué)意義(P㩳0.05),提示他們可能是DIND的危險(xiǎn)因素。進(jìn)一步行Logistic回歸分析發(fā)現(xiàn)吸煙史(OR=0.153,95%CI 0.050-0.466)、腦血管痙攣情況(OR=3.407,95%CI 1.202-9.655)和Fisher分級(OR=6.113,95%CI2.157-17.323)為預(yù)示遲發(fā)性缺血性神經(jīng)功能障礙發(fā)生的獨(dú)立危險(xiǎn)因素,即有吸煙史、腦血管痙攣和Fisher分級高的患者易發(fā)生DIND。經(jīng)過3個(gè)月的隨訪,結(jié)果顯示死亡、植物生存和重度殘疾的患者達(dá)24例,而輕度殘疾和恢復(fù)良好的患者僅有6例,可以看出發(fā)生DIND后,患者的致殘、致死率明顯升高。結(jié)論:aSAH后DIND的發(fā)生是多因素綜合作用的結(jié)果;有吸煙史、腦血管痙攣和Fisher分級高的患者易發(fā)生DIND;發(fā)生DIND后,患者通常預(yù)后不良,應(yīng)積極防治。
[Abstract]:Objective: to screen out the risk factors associated with delayed ischemic neurological dysfunction (delayed ischemic neurological deficittii Dind) by retrospective analysis, and to take measures to intervene in time. In order to improve the therapeutic effect and improve the prognosis of patients with aneurysm subarachnoid hemorrhage (aneurysmal subarachnoid hemia aSAH). Methods: the clinical data and follow-up results of 127 patients with aSAH admitted from March 2014 to September 2016 in neurosurgery Department of affiliated Hospital of Shanxi Medical University were collected. Age, sex, smoking history, cerebral vasospasm, blood pressure at admission, electrocardiogram, white blood cell count, plasma D-dimer, GCS score of aneurysm location, clinical grade and Fisher grade were retrospectively analyzed. The patients were followed up for 3 months to evaluate the prognosis according to the GOS score. According to whether Dind occurred or not, it was divided into two groups: Dind group and non-DIND group. SPSS22.0 statistical software was used to describe the above factors and analyze the influencing factors, and finally to determine the risk factors. Results among 127 cases, 30 cases (23.6%) had delayed ischemic neurological dysfunction, including 15 males and 15 females, the ratio of male to female was 1: 1, the youngest was 35 years old, the maximum age was 78 years, the average age was (53.47 鹵10.76) years. Univariate analysis showed that there were significant differences in smoking history, cerebral vasospasm, GCS score of electrocardiogram, clinical grade and Fisher grade (P 0.05), suggesting that they may be risk factors of DIND. Logistic regression analysis showed that smoking history (ORO 0.153 CI 0.050-0.466), cerebral vasospasm (ORT 3.40795 CI 1.202-9.655) and Fisher grade (OR6.11395CI2.157-17.323) were independent risk factors for predicting delayed ischemic neurological dysfunction, that is, smoking history. Patients with cerebral vasospasm and high Fisher grade were prone to DIND. Following up for 3 months, 24 patients died, vegetative survival and severe disability were found, but only 6 patients with mild disability and good recovery. It can be seen that after DIND, the disability and mortality of the patients increased significantly. Conclusion the occurrence of DIND is the result of multiple factors, the patients with smoking history, cerebral vasospasm and Fisher grade are prone to DIND.The patients with DIND usually have poor prognosis and should be actively prevented from DIND.
【學(xué)位授予單位】：山西醫(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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