動(dòng)脈瘤性蛛網(wǎng)膜下腔出血再出血的危險(xiǎn)因素分析
發(fā)布時(shí)間：2018-08-14 13:05
【摘要】：目的 探討動(dòng)脈瘤性蛛網(wǎng)膜下腔出血(aneurysmal Subarachnoid Hemorrhage, aSAH)患者再出血的危險(xiǎn)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(dòng)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(duì)照組)患者為住院期間未再出血的病例。對(duì)兩組患者的有關(guān)危險(xiǎn)因素進(jìn)行比較。分析患者再出血與性別、年齡、干預(yù)時(shí)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(dòng)脈瘤存在子囊及動(dòng)脈瘤的部位、形態(tài)、大小和數(shù)量、Fisher分級(jí)、]Hunt-Hess分級(jí)、高血壓分級(jí)及格拉斯哥預(yù)后(GOS)評(píng)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(shí)間、動(dòng)脈瘤存在子囊、動(dòng)脈瘤大小、合并高等級(jí)的Fisher分級(jí)、H-H分級(jí)和高血壓分級(jí)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(jí))、高等級(jí)Fisher分級(jí)(Ⅲ～Ⅳ級(jí))、高等級(jí)H-H分級(jí)(Ⅲ～Ⅴ級(jí))、動(dòng)脈瘤存在子囊、動(dòng)脈瘤大小是動(dòng)脈瘤性蛛網(wǎng)膜下腔出血患者再出血的獨(dú)立危險(xiǎn)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(dòng)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(píng)分差異有統(tǒng)計(jì)學(xué)意義(P0.05),再發(fā)組患者GOS評(píng)分明顯低于對(duì)照組患者。 5.再發(fā)組的病死率為42.9%(12/28),對(duì)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(jí)(Ⅲ～Ⅳ級(jí))、H-H分級(jí)(Ⅲ～Ⅴ級(jí))、動(dòng)脈瘤存在子囊、動(dòng)脈瘤直徑≥10mm是再出血的獨(dú)立危險(xiǎn)因素。 2.動(dòng)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(dòng)脈瘤性蛛網(wǎng)膜下腔出血再出血會(huì)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(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.35
本文編號(hào)：2182944
[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(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.35
【參考文獻(xiàn)】
相關(guān)期刊論文 前3條
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