【摘要】：目的 探討動脈瘤性蛛網(wǎng)膜下腔出血(aneurysmal Subarachnoid Hemorrhage, aSAH)患者再出血的危險因素,為臨床早期防治提供依據(jù)。 方法 回顧性分析2010年1月至2013年10月在天津市環(huán)湖醫(yī)院神經(jīng)外科住院的254例診斷為動脈瘤性蛛網(wǎng)膜下腔出血患者,其中28例(再發(fā)組)患者為住院期間再出血的病例,同期住院的226例(對照組)患者為住院期間未再出血的病例。對兩組患者的有關(guān)危險因素進(jìn)行比較。分析患者再出血與性別、年齡、干預(yù)時間、既往高血壓病史、高脂血癥病史、糖尿病病史、吸煙史、飲酒史、動脈瘤存在子囊及動脈瘤的部位、形態(tài)、大小和數(shù)量、Fisher分級、]Hunt-Hess分級、高血壓分級及格拉斯哥預(yù)后(GOS)評分的關(guān)系。所得數(shù)據(jù)采用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果 1.單因素分析顯示兩組患者在年齡、干預(yù)時間、動脈瘤存在子囊、動脈瘤大小、合并高等級的Fisher分級、H-H分級和高血壓分級的比較,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。 2.多因素Logistic回歸分析顯示高血壓(2～3級)、高等級Fisher分級(Ⅲ～Ⅳ級)、高等級H-H分級(Ⅲ～Ⅴ級)、動脈瘤存在子囊、動脈瘤大小是動脈瘤性蛛網(wǎng)膜下腔出血患者再出血的獨(dú)立危險因素(P0.05)。 3.兩組患者在性別、既往存在高血壓病史、高脂血癥病史、糖尿病病史、吸煙、飲酒史以及動脈瘤的部位、形態(tài)和數(shù)量等方面差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。 4.兩組患者的GOS評分差異有統(tǒng)計(jì)學(xué)意義(P0.05),再發(fā)組患者GOS評分明顯低于對照組患者。 5.再發(fā)組的病死率為42.9%(12/28),對照組的病死率為10.2%(23/226),兩組之間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論 1.高血壓收縮壓Fisher分級(Ⅲ～Ⅳ級)、H-H分級(Ⅲ～Ⅴ級)、動脈瘤存在子囊、動脈瘤直徑≥10mm是再出血的獨(dú)立危險因素。 2.動脈瘤性蛛網(wǎng)膜下腔出血患者早期手術(shù)或介入治療能降低再出血率。 3.動脈瘤性蛛網(wǎng)膜下腔出血再出血會顯著增加患者的病死率及致殘率。
[Abstract]:objective
Objective To investigate the risk factors of rebleeding in patients with aneurysmal subarachnoid hemorrhage (aSAH), and to provide evidence for early clinical prevention and treatment.
Method
A retrospective analysis was made of 254 patients with aneurysmal subarachnoid hemorrhage admitted to the Department of Neurosurgery of Tianjin Huanhu Hospital from January 2010 to October 2013. Among them, 28 patients (recurrence group) had recurrent hemorrhage during hospitalization and 226 patients (control group) had no recurrent hemorrhage during hospitalization. Risk factors were compared. Rehaemorrhage and gender, age, intervening time, history of hypertension, hyperlipidemia, diabetes, smoking, drinking, location, shape, size and number of aneurysms with ascites and aneurysms, Fisher classification,]Hunt-Hess classification, hypertension classification and Glasgow Outcome (GOS) score were analyzed. The data were analyzed by SPSS17.0 statistical software.
Result
1. Univariate analysis showed that there were significant differences between the two groups in age, intervening time, aneurysm size, ascus, Fisher classification, H-H classification and hypertension classification (P 0.05).
2. Multivariate logistic regression analysis showed that hypertension (grade 2-3), higher Fisher classification (grade III-IV), higher H-H classification (grade III-V), and aneurysm with ascites were independent risk factors for aneurysmal subarachnoid hemorrhage (P 0.05).
3. There was no significant difference in gender, history of hypertension, hyperlipidemia, diabetes mellitus, smoking, drinking history, location, shape and number of aneurysms between the two groups (P 0.05).
4. There was significant difference in GOS score between the two groups (P 0.05). The GOS score of the relapse group was significantly lower than that of the control group.
5. The mortality of the relapse group was 42.9% (12/28) and that of the control group was 10.2% (23/226). The difference between the two groups was statistically significant (P 0.05).
conclusion
1. Fisher classification of hypertension systolic blood pressure (grade III-IV), H-H classification (grade III-V), aneurysm with ascus, aneurysm diameter (>10 mm) is an independent risk factor for rebleeding.
2. early surgery or interventional therapy for aneurysmal subarachnoid hemorrhage can reduce the rate of rebleeding.
3. the rebleeding of aneurysmal subarachnoid hemorrhage will significantly increase the mortality and disability rate of patients.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.35

【參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 張晉,王曉良;內(nèi)皮源性血管活性因子的研究進(jìn)展[J];中國藥理學(xué)通報(bào);2000年01期

2 劉海洋;韓如泉;;蛛網(wǎng)膜下腔出血后遲發(fā)缺血性神經(jīng)功能損害的研究進(jìn)展[J];中華臨床醫(yī)師雜志(電子版);2010年08期

3 趙煒疆;秘勇建;;實(shí)驗(yàn)性蛛網(wǎng)膜下腔出血凋亡機(jī)制及干預(yù)治療研究[J];中華臨床醫(yī)師雜志(電子版);2011年23期

，

本文編號：2182944