【摘要】：目的：腦血管痙攣（cerebral vasospasm，CVS）是動(dòng)脈瘤性蛛網(wǎng)膜下腔出血（aneurysmal subarachnoid hemorrhage，aSAH）的嚴(yán)重并發(fā)癥之一，也是其致殘及致死的主要原因，嚴(yán)重影響著患者的預(yù)后。目前對(duì)于CVS的發(fā)病機(jī)制尚未完全闡明。近年來(lái)，國(guó)外研究發(fā)現(xiàn)交感神經(jīng)的病理性亢進(jìn)的機(jī)制可能與CVS的發(fā)生有關(guān)，同時(shí)中樞交感神經(jīng)活性的增加可能跟aSAH后心電圖的異常有關(guān)。為進(jìn)一步證實(shí)心電圖異常跟血管痙攣之間存在關(guān)聯(lián)，本研究回顧性的分析動(dòng)脈瘤性蛛網(wǎng)膜下腔出血的患者早期心電圖表現(xiàn)與腦血管痙攣之間的關(guān)聯(lián)，并結(jié)合其他實(shí)驗(yàn)室及臨床各項(xiàng)觀測(cè)指標(biāo)同時(shí)進(jìn)行統(tǒng)計(jì)學(xué)分析，篩選出有顯著相關(guān)的危險(xiǎn)因素，從中觀察心電圖改變與血管痙攣之間的關(guān)聯(lián)。進(jìn)一步為降低aSAH后CVS的發(fā)病率，改善患者的預(yù)后提供相應(yīng)的依據(jù)。 方法：選取河北醫(yī)科大學(xué)附屬第二醫(yī)院神經(jīng)外科在2012年6月至2013年9月期間收治的193例顱內(nèi)動(dòng)脈瘤破裂所致的蛛網(wǎng)膜下腔出血患者，對(duì)出血后24小時(shí)內(nèi)心電圖表現(xiàn)及其他臨床及實(shí)驗(yàn)室觀測(cè)指標(biāo)與腦血管痙攣之間的關(guān)系進(jìn)行回顧性的分析。并對(duì)患者進(jìn)行了6個(gè)月的隨訪。統(tǒng)計(jì)方法采用SPSS18.0統(tǒng)計(jì)分析軟件進(jìn)行分析，對(duì)數(shù)據(jù)行單因素卡方檢驗(yàn)及多因素Logistic回歸分析，檢驗(yàn)水準(zhǔn)P=0.05。 結(jié)果：193例患者中66例發(fā)生CVS，發(fā)病率為34.2%。共128例患者出現(xiàn)了不同程度的心電圖異常改變，經(jīng)單因素卡方檢驗(yàn)及多因素Logistic回歸分析，QT間期延長(zhǎng)為腦血管痙攣發(fā)生的獨(dú)立危險(xiǎn)因素（OR=8.304,95%CI：3.624~19.025）,其他心電圖異常表現(xiàn)對(duì)腦血管痙攣的發(fā)病率差異無(wú)統(tǒng)計(jì)學(xué)意義（p㧐0.05）。臨床及實(shí)驗(yàn)室觀測(cè)指標(biāo)中，有吸煙史(OR=5.743，95%CI：2.373~13.897)、低鈉血癥（OR=2.038,95%CI:1.065~3.902）、WFNS分級(jí)"gⅣ級(jí)（OR=2.820,95%CI：1.204~6.604）、Fisher分級(jí)"g3級(jí)（OR=3.369,95%CI:1.372~8.271）均為腦血管痙攣發(fā)生的獨(dú)立危險(xiǎn)因素。白細(xì)胞計(jì)數(shù)及手術(shù)時(shí)機(jī)為腦血管痙攣發(fā)生的危險(xiǎn)因素（p㩳0.05）。對(duì)患者進(jìn)行6個(gè)月隨訪，共死亡33(17.1%)例，重殘患者共32(16.6%)例，進(jìn)行分組后計(jì)算，結(jié)果顯示發(fā)生腦血管痙攣的患者，殘疾率及死亡率均明顯升高(P0.05)。 結(jié)論：1動(dòng)脈瘤性蛛網(wǎng)膜下腔出血的患者早期心電圖中QT間期延長(zhǎng)是腦血管痙攣發(fā)生的獨(dú)立危險(xiǎn)因素，，QT間期延長(zhǎng)的患者腦血管痙攣的發(fā)病率明顯高于QT間期正常的患者。2有吸煙史、低鈉血癥、WFNS分級(jí)"gⅣ級(jí)、Fisher分級(jí)"g3級(jí)為動(dòng)脈瘤性蛛網(wǎng)膜下腔出血后腦血管痙攣的獨(dú)立預(yù)測(cè)因素，應(yīng)密切監(jiān)測(cè)，積極預(yù)防及治療。白細(xì)胞計(jì)數(shù)增高為腦血管痙攣的危險(xiǎn)因素，檢測(cè)患者的白細(xì)胞計(jì)數(shù)有助于腦血管痙攣的早期診斷及治療。3動(dòng)脈瘤性蛛網(wǎng)膜下腔出血的患者宜于出血后三天內(nèi)早期行手術(shù)治療。4發(fā)生腦血管痙攣的患者預(yù)后較差，致死率及致殘率明顯升高，應(yīng)早期給予積極治療。
[Abstract]:Aim: cerebral vasospasm (cerebral vasospasm,CVS) is one of the serious complications of aneurysm subarachnoid hemorrhage (aneurysmal subarachnoid hemorrhage,aSAH). It is also the main cause of disability and death, which seriously affects the prognosis of patients. At present, the pathogenesis of CVS has not been fully clarified. In recent years, studies abroad have found that the mechanism of pathological hyperactivity of sympathetic nerve may be related to the occurrence of CVS, and the increase of central sympathetic nerve activity may be related to abnormal electrocardiogram after aSAH. To further confirm the association between abnormal electrocardiogram and vasospasm, this study retrospectively analyzed the association between early ECG manifestations and cerebral vasospasm in patients with aneurysm subarachnoid hemorrhage. Combined with other laboratory and clinical observations, statistical analysis was carried out at the same time to screen out the risk factors with significant correlation, from which to observe the relationship between ECG changes and vasospasm. To further reduce the incidence of CVS after aSAH and improve the prognosis of the patients to provide the corresponding basis. Methods: 193 patients with subarachnoid hemorrhage caused by ruptured intracranial aneurysm were selected from the neurosurgery department of the second affiliated Hospital of Hebei Medical University from June 2012 to September 2013. The relationship between 24-hour electrocardiogram (EMG) and other clinical and laboratory observations and cerebral vasospasm (CVS) was analyzed retrospectively. The patients were followed up for 6 months. The statistical methods were analyzed by SPSS18.0 statistical analysis software. The single factor chi-square test and multi-factor Logistic regression analysis were used to test the level of P0. 05. Results: the incidence of CVS, in 66 of 193 patients was 34.2%. After univariate chi-square test and multi-factor Logistic regression analysis, the prolongation of QT interval was an independent risk factor (OR=8.304,95%CI:3.624~19.025) for the occurrence of cerebral vasospasm. There was no significant difference in the incidence of cerebral vasospasm between other abnormal ECG manifestations (p < 0.05). Among the clinical and laboratory indexes, smoking history (OR=5.743,95%CI:2.373~13.897), hyponatremia (OR=2.038,95%CI:1.065~3.902), WFNS grade "g鈪

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