2021 年第 12 期 第 16 卷

动脉瘤性蛛网膜下腔出血手术治疗后患者的不良预后因素评估

Evaluation of poor prognostic factors in patients after surgical treatment of aneurysmal subarachnoid hemorrhage

作者：姬培培1伍艳春2张庆英3许锦成1陈慕媛1

英文作者：Ji Peipei1 Wu Yanchun2 Zhang Qingying3 Xu Jincheng1 Chen Muyuan1

单位：1汕头大学医学院第一附属医院神经外科515041；2汕头大学医学院第一附属医院护理学研究院515041；3汕头大学医学院公共卫生与预防医学教研室515041

英文单位：1Department of Neurosurgery the First Affiliated Hospital of Shantou University Medical College Shantou 515041 China; 2Nursing Institute the First Affiliated Hospital of Shantou University Medical College Shantou 515041 China; 3Department of Public Health and Preventive Medicine Shantou University Medical College Shantou 515041 China

关键词：蛛网膜下腔出血；颅内动脉瘤；手术治疗；预后

英文关键词：Subarachnoidhemorrhage;Intracranialaneurysm;Surgicaltreatment;Prognosis

• 摘要：

• 目的 探讨动脉瘤性蛛网膜下腔出血（aSAH）手术治疗后患者不良预后的影响因素。方法 选取2015年1月至2019年12月于汕头大学医学院第一附属医院接受手术治疗的aSAH患者297例。根据出院时改良Rankin量表（mRS）评分将患者分为预后良好组（171例）和预后不良组（126例）。收集并比较2组的基本信息及临床资料。采用二分类Logisitc回归方法分析影响aSAH患者不良预后的因素。采用受试者工作特征（ROC）曲线分析联合因素对aSAH不良预后的预测价值。结果  预后不良组年龄≥60岁、高血压病史、Hunt-Hess分级Ⅳ～Ⅴ级、CT Fisher分级Ⅲ～Ⅳ级、脑室内积血、脑内血肿、术后肺部感染、术后脑梗死、院内再出血比例及住院时间均高于/长于预后良好组，警告性头痛比例低于预后良好组，差异均有统计学意义（均P＜0.05）。二分类Logisitc回归分析结果显示, 年龄≥60岁（比值比=2.157，95%置信区间：1.081~4.304）、Hunt-Hess分级Ⅳ～Ⅴ级（比值比=10.264，95%置信区间：3.540~29.761）、CT Fisher分级Ⅲ～Ⅳ级（比值比=6.796，95%置信区间：3.196~14.453）、院内再出血（比值比=3.228，95%置信区间：1.611~6.466）、脑梗死（比值比=12.889，95%置信区间：5.599~29.670）与aSAH术后出现不良预后有关（均P＜0.05）。ROC曲线分析结果显示，年龄、Hunt-Hess分级、CT Fisher分级、院内再出血、脑梗死联合预测aSAH术后出现不良预后的曲线下面积为0.908（95%置信区间：0.874～0.943，P＜0.001）。结论  患者年龄越大、Hunt-Hess分级及CT Fisher分级高、伴有院内再出血及术后脑梗死是影响aSAH术后不良预后的危险因素。

• Objective To evaluate the poor prognostic factors in patients after surgical treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods From January 2015 to December 2019, 297 patients with aSAH who underwent surgical treatment in the First Affiliated Hospital of Shantou University Medical College were collected. According to the modified Rankin scale (mRS) score at discharge, patients were divided into good prognosis group (171 cases) and poor prognosis group (126 cases). The general information and clinical data were collected and compared between the two groups. Binary Logisitc regression analysis was used to analyze the factors for poor prognosis in aSAH patients. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of combined factors in poor prognosis of aSAH. Results The rates of age≥60 years old, hypertension, Hunt-Hess grading Ⅳ-Ⅴ, CT Fisher grading Ⅲ-Ⅳ, intraventricular hematocele and intracerebral hematoma, postoperative pulmonary infection, postoperative cerebral infarction, hospital rebleeding and length of stay in poor prognosis group were higher/longer than those in good prognosis group, and the rate of warning headache in poor prognosis group was lower than that in good prognosis group (all P<0.05). Binary Logistic regression analysis showed that age≥60 years (odds ratio=2.157, 95% confidence interval: 1.081-4.304), Hunt-Hess grading Ⅳ-Ⅴ (odds ratio=10.264, 95% confidence interval: 3.540-29.761), CT Fisher grading Ⅲ-Ⅳ(odds ratio=6.796, 95% confidence interval: 3.196-14.453), hospital rebleeding(odds ratio=3.228, 95% confidence interval: 1.611-6.466) and cerebral infarction(odds ratio=12.889, 95% confidence interval: 5.599-29.670) were associated with poor prognosis of aSAH after operation. ROC curve analysis showed that the area under the curve for age, Hunt-Hess grade, CT Fisher grade, hospital rebleeding and cerebral infarction combined to predict the poor prognosis of aSAH was 0.908 (95% confidence interval: 0.874-0.943, P<0.001) after operation. Conclusion  The older, higher Hunt-Hess grade and CT Fisher grade, and accompanied by hospital rebleeding and postoperative cerebral infarction are the risk factors affecting the poor prognosis in patient with aSAH after surgical treatment.