文章摘要
汪新宇,李 军,王 铮,华 磊,李中林.动脉瘤性蛛网膜下腔出血后持续腰大池引流的时机探讨及分流依赖性脑积水的危险因素分析[J].,2021,(14):2782-2786
动脉瘤性蛛网膜下腔出血后持续腰大池引流的时机探讨及分流依赖性脑积水的危险因素分析
Timing of Continuous Lumbar Cistern Drainage after Aneurysmal Subarachnoid Hemorrhage and Risk Factors of Shunt-dependent Hydrocephalus
投稿时间:2021-02-10  修订日期:2021-03-06
DOI:10.13241/j.cnki.pmb.2021.14.039
中文关键词: 动脉瘤性蛛网膜下腔出血  持续腰大池引流  分流依赖性脑积水  危险因素
英文关键词: Aneurysmal subarachnoid hemorrhage  Continuous lumbar cistern drainage  Shunt-dependent hydrocephalus  Risk factors
基金项目:江苏省自然科学基金项目(BK20181152)
作者单位E-mail
汪新宇 徐州医科大学附属医院神经外科 江苏 徐州 221000 wxy15952159270@163.com 
李 军 徐州医科大学附属医院神经外科 江苏 徐州 221000  
王 铮 徐州医科大学附属医院神经外科 江苏 徐州 221000  
华 磊 徐州医科大学附属医院神经外科 江苏 徐州 221000  
李中林 徐州医科大学附属医院神经外科 江苏 徐州 221000  
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中文摘要:
      摘要 目的:研究对比动脉瘤性蛛网膜下腔出血(aSAH)后不同时机开展持续腰大池引流的效果,并对分流依赖性脑积水(SDHC)的危险因素进行分析。方法:本院于2017年1月~2020年12月期间诊治的aSAH患者171例,将其纳入研究。将其按照持续腰大池引流时机不同分为A组(<24 h)50例、B组(24~72h)84例以及C组(>72 h)37例。观察三组头痛持续时间,双侧大脑中动脉(MAC)血流流速以及SDHC发生率,对aSAH后持续腰大池引流术后并发SDHC的影响因素进行单因素和多因素Logistic回归分析。结果:C组头痛持续时间长于A组和B组,MAC血流流速快于A组和B组,SDHC发生率高于A组和B组(均P<0.05);而A组和B组上述指标对比差异均不明显(均P>0.05),但是A组SDHC发生率更低。经单因素分析可得:aSAH持续腰大池引流术后并发SDHC和年龄、病变部位、中枢神经系统感染、改良Fisher分级及Hunt-Hess评分有关(均P<0.05)。经多因素Logistic回归分析可得:年龄≥60岁、病变部位后循环、中枢神经系统感染、改良Fisher分级Ⅲ~Ⅳ级、Hunt-Hess评分Ⅲ~Ⅳ级及持续腰大池引流≥24 h均是aSAH持续腰大池引流术后并发SDHC的危险因素(均OR>1,P<0.05)。结论:以aSAH后<24 h为时机开展持续腰大池引流术的效果较佳,SDHC发生率更低,其中年龄、病变部位、中枢神经系统感染、改良Fisher分级、Hunt-Hess评分、持续腰大池引流时机与aSAH持续腰大池引流术后并发SDHC的风险有关,临床工作中应针对上述因素制定相关措施,以期达到降低SDHC发生风险的目的。
英文摘要:
      ABSTRACT Objective: To study and compare the effects of continuous lumbar cistern drainage at different times after aneurysmal subarachnoid hemorrhage (ASAH), and to analyze the risk factors of shunt-dependent hydrocephalus (SDHC). Methods: 171 patients with aSAH were diagnosed and treated in our hospital from January 2017 to December 2020,they were included in the study. The patients were divided into group A (< 24 h) 50 cases, group B (24~72 h) 84 cases, and group C (>72 h) 37 cases according to the difference in the timing of continuous lumbar cierge drainage. The headache duration time, bilateral middle cerebral artery (MAC) flow rate and the incidence rate of SDHC in the three groups were observed. Univariate and multivariate Logistic regression analysis was performed on the influencing factors of SDHC after continuous lumbar cistrum drainage after aASAH. Results: The headache duration time of group C was longer than that of group A and B, MAC blood flow velocity was faster than that of group A and B, and the incidence rate of SDHC was higher than that of group A and B (all P<0.05). There were no significant differences in the above indexes between group A and group B (all P>0.05) , but the incidence of SDHC in group A was lower. Univariate analysis showed that SDHC after aASAH continuous lumbar cistrum drainage was associated with age, lesion site, central nervous system infection, improved Fisher grade and Hunt-Hess score (all P<0.05). The multivariate Logistic regression analysis available: age≥60 years, lesion site posterior circulation, the central nervous system infection, improved Fisher class Ⅲ~Ⅳ grade, Hunt-Hess score Ⅲ~Ⅳ grade, continuous lumbar cistern drainage ≥24 h were aSAH continuous lumbar drainage of large pool independent risk factors for postoperative concurrent SDHC (all OR>1, P<0.05). Conclusion: When the time is less than 24 hours after aSAH, the effect of continuous lumbar cistern drainage is better, and the incidence of SDHC is lower, the age, pathological location, central nervous system infection, modified Fisher grade, hunt Hess score, and the timing of continuous cistern drainage were related to the risk of SDHC after continuous lumbar cistern drainage, in order to reduce the risk of SDHC, relevant measures should be taken in clinical work.
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