【摘要】：第一部分動(dòng)脈瘤性蛛網(wǎng)膜下腔出血后遲發(fā)性腦缺血影響因素META分析目的目前關(guān)于動(dòng)脈瘤性蛛網(wǎng)膜下腔出血后發(fā)生遲發(fā)性腦缺血(DCI)的影響因素的報(bào)道尚不統(tǒng)一,尤其是關(guān)于手術(shù)和介入治療對(duì)DCI的不同的影響結(jié)果的報(bào)道仍有分歧。因此本課題通過Meta分析,探討動(dòng)脈瘤性蛛網(wǎng)膜下腔出血后發(fā)生遲發(fā)性腦缺血的影響因素及其相關(guān)危險(xiǎn)度,為動(dòng)脈瘤性蛛網(wǎng)膜下腔出血(aSAH)患者預(yù)防DCI提供理論依據(jù)。方法搜集PubMed上近10年關(guān)于動(dòng)脈瘤性蛛網(wǎng)膜下腔出血后遲發(fā)性腦缺血影響因素相關(guān)的文獻(xiàn),利用Revman 5.2軟件對(duì)納入文獻(xiàn)相關(guān)指標(biāo)畸形META分析,計(jì)算每個(gè)影響因素的優(yōu)勢(shì)比(OR值)及95%置信區(qū)間。結(jié)果此次研究共納入13篇相關(guān)文獻(xiàn),共5084名患者,其中發(fā)生DCI的患者為1338人,DCI總發(fā)生率為26.3%。Meta分析結(jié)果還提示各因素合并OR值及95%置信區(qū)間分別:性別0.87(0.68-1.12)、高血壓(Hypertension)病史1.26(0.76-2.09)、吸煙史1.28(0.92-1.77)、入院時(shí)臨床分級(jí)(Clinical Grade)0.35(0.27-0.46)、Fisher分級(jí)0.38(0.22-0.65)、治療方式0.70(0.60-0.81)、動(dòng)脈瘤位置1.23(0.88-1.71)。結(jié)論入院時(shí)臨床分級(jí)、Fisher分級(jí)及動(dòng)脈瘤的治療方式是影響動(dòng)脈瘤性蛛網(wǎng)膜下腔出血后發(fā)生遲發(fā)性腦缺血的影響因素,而性別、高血壓病史、吸煙史、動(dòng)脈瘤位置未顯示出有明顯相關(guān)性。第二部分 破裂動(dòng)脈瘤術(shù)后遲發(fā)性腦缺血的影響因素分析(單中心)目的分析本院破裂動(dòng)脈瘤術(shù)后出現(xiàn)遲發(fā)性腦缺血的發(fā)生率、影響因素和相關(guān)臨床特點(diǎn),更深入的研究遲發(fā)性腦缺血的影響因素,以期為改善蛛網(wǎng)膜下腔出血患者的預(yù)后提供進(jìn)一步的理論依據(jù)。方法回顧性分析我院自2013年1月至2016年6月入院的動(dòng)脈瘤破裂后蛛網(wǎng)膜下腔出血2周內(nèi)行手術(shù)治療的患者臨床資料,分析遲發(fā)性腦缺血的影響因素及發(fā)病特點(diǎn)。結(jié)果破裂動(dòng)脈術(shù)后遲發(fā)性腦缺血發(fā)生率為10.7%,經(jīng)多元回歸分析提示治療方式(開顱夾閉或介入栓塞)(OR=6.645,P0.05)和Fisher分級(jí)(OR=5.325,P0.05)是影響破裂動(dòng)脈瘤患者出現(xiàn)遲發(fā)性腦缺血的危險(xiǎn)因素。在Fisher分級(jí)I-II級(jí)的病人中,栓塞組病人和夾閉組病人DCI的發(fā)生率均很低,分別為2.4%和4.8%。在Fisher分級(jí)III-IV級(jí)時(shí)栓塞組病人和夾閉組病人DCI發(fā)病率分別為3.4%和27.7%,且兩者有統(tǒng)計(jì)學(xué)差異(P0.05)。遲發(fā)性腦缺血的部位可以在手術(shù)同側(cè),也可以在手術(shù)對(duì)側(cè)。DSA造影顯示,血管痙攣較嚴(yán)重的一側(cè),均發(fā)生在SAH較重的一側(cè)。結(jié)論治療方式和Fisher分級(jí)均是破裂動(dòng)脈瘤術(shù)后DCI的危險(xiǎn)因素,即只有在Fisher分級(jí)≥3級(jí)的患者行夾閉手術(shù)時(shí)對(duì)DCI發(fā)生具有高度危險(xiǎn)性,而且腦缺血的部位與蛛網(wǎng)膜下腔出血波及的范圍相關(guān),且出血較多的部位,發(fā)生血管痙攣更為嚴(yán)重。
[Abstract]:Part I factors affecting delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage objective to analyze the factors affecting delayed cerebral ischemia (DCI) after aneurysm subarachnoid hemorrhage (SAH). In particular, reports of the different effects of surgery and interventional therapy on DCI remain controversial. In order to provide a theoretical basis for the prevention of DCI in patients with aneurysm subarachnoid hemorrhage (aSAH), the influencing factors and the related risk of delayed cerebral ischemia after aneurysm subarachnoid hemorrhage (SAH) were investigated by Meta analysis. Methods the literatures about the factors related to delayed cerebral ischemia after aneurysm subarachnoid hemorrhage (SAH) were collected on PubMed in recent 10 years. META analysis was used to analyze the deformity of the related indexes by using Revman 5.2 software. The odds ratio (OR) and 95% confidence interval of each factor were calculated. Results the study included 13 related articles, including 5084 patients. There were 1338 patients with DCI. The total incidence of DCI was analyzed by 26.3%.Meta. The results of 26.3%.Meta analysis also showed that the factors combined with OR and 95% confidence interval were: sex 0.87 (0.68-1.12), history of hypertension (Hypertension) 1.26 (0.76-2.09), smoking history 1.28 (0.92-1.77), clinical (Clinical Grade) 0.35 (0.27-0.46), Fisher) 0.38 (0.22-0.65), treatment side. Type 0.70 (0.60-0.81), aneurysm position 1.23 (0.88-1.71). Conclusion Clinical grade, Fisher grade and treatment of aneurysm on admission are the influencing factors of delayed cerebral ischemia after aneurysm subarachnoid hemorrhage, but gender, history of hypertension, history of smoking, etc. There was no obvious correlation between the location of aneurysm. The second part: analysis of the influencing factors of delayed cerebral ischemia after ruptured aneurysm (single center) objective to analyze the incidence, influencing factors and related clinical characteristics of delayed cerebral ischemia after ruptured aneurysm in our hospital. In order to improve the prognosis of patients with subarachnoid hemorrhage (SAH), the factors affecting delayed cerebral ischemia were further studied in order to provide further theoretical basis for improving the prognosis of patients with subarachnoid hemorrhage. Methods the clinical data of patients with subarachnoid hemorrhage after aneurysm rupture in our hospital from January 2013 to June 2016 were analyzed retrospectively. The influencing factors and characteristics of delayed cerebral ischemia were analyzed. Results the incidence of delayed cerebral ischemia after ruptured artery operation was 10.7. Multiple regression analysis indicated that the treatment methods (craniotomy or interventional embolization) (OR=6.645,P0.05) and Fisher grade (OR=5.325,P0.05) were the risk factors for delayed cerebral ischemia in patients with ruptured aneurysms. The incidence of DCI in embolization group and clipping group was very low (2.4% and 4.8%, respectively) in patients with Fisher grade I-II. The incidence of DCI in embolization group and clipping group was 3.4% and 27.7% respectively when Fisher grade was III-IV grade, and there was statistical difference between them (P0.05). The location of delayed cerebral ischemia can be found on the same side of the operation or on the opposite side of the operation. DSA angiography showed that the side with severe vasospasm occurred in the side with the heavier SAH. Conclusion treatment and Fisher grading are the risk factors of DCI after ruptured aneurysm, that is, only those patients with Fisher grade 鈮，

本文編號(hào)：2272829