【摘要】：目的:研究動脈瘤夾閉術(shù)后患者腦脊液乳酸(CSFL)濃度與蛛網(wǎng)膜下腔出血量、Hunt-Hess分級、GCS評分、GOS評分及并發(fā)癥的發(fā)生之間的關(guān)系,探討CSFL濃度與動脈瘤夾閉術(shù)后患者預后的關(guān)系。方法:通過利用血氣分析儀對顱內(nèi)動脈瘤開顱夾閉術(shù)后患者不同時間同時進行血和CSFL濃度的檢測,以及對患者術(shù)后隨訪6月,并行GOS評分。統(tǒng)計分析CSFL濃度與蛛網(wǎng)膜下腔出血量、GCS評分、Hunt-Hess分級、GOS評分之間的關(guān)系,并觀察血與腦脊液中乳酸濃度是否存在相關(guān)性,術(shù)后動態(tài)復查頭顱CT,觀察有無腦積水、腦梗死等并發(fā)癥表現(xiàn),并根據(jù)CSFL濃度進行分組,統(tǒng)計各組并發(fā)癥發(fā)生的差異。結(jié)果:?CSFL濃度與蛛網(wǎng)膜下腔出血量Pearson相關(guān)系數(shù)(r=0.638,P=0.0000.001(雙側(cè)檢驗));?CSFL濃度與GOS評分之間Pearson相關(guān)系數(shù)為(r=-0.794,P=0.0000.001(雙側(cè)));?CSFL濃度與GCS評分之間Pearson相關(guān)系數(shù)為(r=-0.752,P=0.0000.001(雙側(cè)));④CSFL濃度與Hunt-Hess分級之間Pearson相關(guān)系數(shù)為(r=0.694,P=0.0000.001(雙側(cè)));⑤無并發(fā)癥組的CSFL濃度(2.09±0.47)mmol/L,并發(fā)癥組的CSFL濃度(3.52±1.17)mmol/L,兩組之間t檢驗P=0.0000.001,存在明顯統(tǒng)計學差異;⑥血乳酸濃度變化與CSFL濃度相關(guān),但血乳酸濃度值位于正常范圍內(nèi);⑦當CSFL濃度3.0mmol/L時,并發(fā)癥明顯增加,而預后明顯變差。結(jié)論:1、CSFL濃度與動脈瘤破裂出血后蛛網(wǎng)膜下腔出血量、GOS、Hunt-Hess分級、GCS評分及并發(fā)癥的發(fā)生等顯著相關(guān),FISHER分級越高,Hunt-Hess分級越高,CSFL濃度越高,預后越差。CSFL濃度可作為顱內(nèi)動脈瘤術(shù)后早期評價預后的一項參考指標;2、CSFL濃度輕度升高(≤3.0mmol/L)時,預后無明顯統(tǒng)計學意義,CSFL濃度明顯升高(3.0mmol/L)時,預后明顯變差。
[Abstract]:Objective: to study the relationship between cerebrospinal fluid lactate (CSFL) concentration and subarachnoid hemorrhage, Hunt-Hess grade, GCS score, GOS score and complications after aneurysm clipping. To investigate the relationship between the concentration of CSFL and the prognosis of patients after aneurysm clipping. Methods: blood and CSFL concentrations were measured at different times after intracranial aneurysm clipping by blood gas analyzer. The patients were followed up for 6 months with GOS score. The relationship between the concentration of CSFL and subarachnoid hemorrhage, GCS score, Hunt-Hess grade, GOS score was analyzed statistically, and the correlation between blood and cerebrospinal fluid lactate concentration was observed. Complications such as cerebral infarction were divided into groups according to the concentration of CSFL. Results: the Pearson correlation coefficient between CSFL concentration and subarachnoid hemorrhage was 0.0000.001 (r = 0.638P 0.0000.001). The Pearson correlation coefficient between);? CSFL concentration and GOS score was (r = -0.794P = 0.0000.001) (bilateral);). The Pearson correlation coefficient between the CSFL concentration and the GCS score was 0.0000.001 (r = 0.752P0. 0000. 001) (the Pearson correlation coefficient between the bilateral); 4CSFL concentration and the Hunt-Hess grade was 0. 0000. 001 (r = 0. 694 0. 001) (bilateral);). 5 the CSFL concentration in the non-complication group (2.09 鹵0.47), the CSFL concentration in the complication group (3.52 鹵1.17) mmol/L, was significantly different between the two groups (t test 0.0000.001). (6) the change of blood lactate concentration was related to the concentration of CSFL, but the concentration of blood lactate was in the normal range. 7 when the concentration of CSFL was 3.0mmol/L, the complications increased significantly and the prognosis became worse. Conclusion: 1 the concentration of CSFL is significantly correlated with the amount of subarachnoid hemorrhage, GOS,Hunt-Hess grade, GCS score and complication after rupture of aneurysm. The higher the FISHER grade, the higher the Hunt-Hess grade and the higher the CSFL concentration. The worse the prognosis is, the CSFL concentration can be used as a reference index for early evaluation of prognosis after intracranial aneurysm surgery. 2the prognosis of patients with slight increase of CSFL concentration (鈮，

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