摘要
目的 探讨FisherⅢ-Ⅳ级颅内动脉瘤性蛛网膜下腔出血患者并脑积水的相关危险因素。方法 纳入宁夏医科大学总医院神经外科2015年5月—2022年1月收治的313例破裂颅内动脉瘤性蛛网膜下腔出血FisherⅢ-Ⅳ患者,根据不同治疗方式,分别比较并发脑积水和非脑积水2组患者的临床数据资料,经多因素Logistic回归分析患者发生脑积水的独立危险因素。通过独立危险因素构建预测模型,结合受试者工作特征(ROC)曲线,分析模型对患者并发脑积水的预测价值。结果 经单因素分析出开颅夹闭和血管内患者术后合并脑积水分别与FisherⅣ级(P=0.004)、持续腰大池引流(LD)(P=0.017)和Hunt-HessⅢ-V级(P=0.003)、FisherⅣ级(P=0.005)、去骨瓣减压术(P=0.042)、肺炎(P=0.016)相关。经多因素分析得出,开颅夹闭后并脑积水发生的独立危险因素为FisherⅣ级[P=0.007,优势比(OR)=17.949,OR 95%置信区间(CI):2.181~147.682],LD(P=0.003,OR=4.717,OR 95%CI:1.486~89.027)。ROC曲线分析显示,FisherⅣ级+LD[曲线下面积(AUC)=0.747 8,95%CI:0.644 3~0.851 4,P=0.000 2,P_(H-L)=0.851]。血管内栓塞后并脑积水发生的独立危险因素为FisherⅣ级(P=0.048,OR=3.598,OR 95%CI:1.014~12.768),Hunt-HessⅢ-V级(P=0.039,OR=8.610,OR 95%CI:1.113~66.583)。ROC曲线分析显示,FisherⅣ级+Hunt-HessⅢ-V级(AUC=0.705 1,95%CI:0.617 5~0.792 6,P=0.000 8,P_(H-L)=0.789)。结论 颅内破裂动脉瘤Fisher分级Ⅲ-Ⅳ级患者发生脑积水独立危险因素因不同治疗方式而不同。开颅夹闭和血管内栓塞后并发脑积水的独立危险因素分别为FisherⅣ级、持续LD和FisherⅣ级、Hunt-HessⅢ-Ⅳ级。
Objective To explore the related risk factors of hydrocephalus in Fisher gradeⅢ-Ⅳpatients.Methods 313 FisherⅢ-Ⅳpatients of ruptured aneurysm treated in the Department of Neurosurgery,General Hospital of Ningxia Medical University from May 2015 to January 2022 were included.The clinical data of two groups of patients with hydrocephalus and non-hydrocephalus according to different treatment methods were collected,and the independent risk factors of hydrocephalus were analyzed by multivariate logistic regression.The predictive model was constructed by independent risk factors,and combined with the receiver operating characteristic(ROC)curve analysis model to predict the value of patients with hydrocephalus.Results Univariate analysis showed that postoperative hydrocephalus in patients with clipping and coiling was associated with FisherⅣgrade(P=0.004),subarachnoid continuous lumbar drainage(LD)(P=0.017),and Hunt-HessⅢ-V grade(P=0.003),FisherⅣgrade(P=0.005),decompressive craniectomy(P=0.042),and pneumonia(P=0.016),respectively.Based on multiple factor analysis,it is concluded that the independent risk factors of hydrocephalus after clipping were FisherⅣgrade[P=0.007,odds ratio(OR)=17.949,OR 95%confidence interval(CI):2.181-147.682],and LD(P=0.003,OR=4.717,OR 95%CI:1.486-89.027).ROC curve analysis showed that FisherⅣgrade+LD(AUC=0.7478,95%CI:0.6443-0.8514,P=0.0002,P _(H-L)=0.851).The independent risk factors of hydrocephalus after coiling were FisherⅣ(P=0.048,OR=3.598,OR 95%CI:1.014-12.768)and Hunt HessⅢ-V(P=0.039,OR=8.610,OR 95%CI:1.13-66.583).ROC curve analysis showed that FisherⅣgrade+Hunt LessⅢ-V grade(AUC=0.7051,95%CI:0.6175-0.7926,P=0.0008,P_(H-L)=0.789).Conclusions Different treatment methods can lead to different independent risk factors of hydrocephalus in patients with intracranial ruptured aneurysms of FisherⅢ-Ⅳgrade.The factors of clipping and coiling were FisherⅣ,LD,and FisherⅣ,Hunt HessⅢ-Ⅳ,respectively.
作者
冯进
孙阳阳
颜华
万定
杨振兴
黄德俊
李宗正
FENG Jin;SUN Yangyang;YAN Hua(Department of Neurosurgery,General Hospital of Ningxia Medical University,Yinchuan 750004,China;不详)
出处
《临床神经外科杂志》
2024年第1期59-64,71,共7页
Journal of Clinical Neurosurgery
基金
宁夏回族自治区重点研发计划项目(2018BEG03021)。
关键词
颅内动脉瘤
蛛网膜下腔出血
治疗
脑积水
引流
影响因素
intracranial aneurysm
subarachnoid hemorrhage
treatment
hydrocephalus
drainage
influencing factor
