[1]张峰涛,王冠军,赵中甫.蛛网膜下腔出血患者脑血管痉挛危险因素分析[J].新乡医学院学报,2022,39(5):450-453.[doi:10.7683/xxyxyxb.2022.05.010]
 ZHANG Fengtao,WANG Guanjun,ZHAO Zhongfu.Analysis of the risk factors for cerebral vasospasm in patients with subarachnoid hemorrhage[J].Journal of Xinxiang Medical University,2022,39(5):450-453.[doi:10.7683/xxyxyxb.2022.05.010]
点击复制

蛛网膜下腔出血患者脑血管痉挛危险因素分析
分享到:

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年5
页码:
450-453
栏目:
临床研究
出版日期:
2022-05-05

文章信息/Info

Title:
Analysis of the risk factors for cerebral vasospasm in patients with subarachnoid hemorrhage
作者:
张峰涛王冠军赵中甫
(许昌市中心医院神经外科,河南 许昌 461000)
Author(s):
ZHANG FengtaoWANG GuanjunZHAO Zhongfu
(Department of Neurosurgery,Xuchang Central Hospital,Xuchang 461000,Henan Province,China)
关键词:
蛛网膜下腔出血脑血管痉挛危险因素
Keywords:
subarachnoid hemorrhagecerebral vasospasmrisk factor
分类号:
R743.3
DOI:
10.7683/xxyxyxb.2022.05.010
文献标志码:
A
摘要:
目的 探讨蛛网膜下腔出血(SAH)患者发生脑血管痉挛(CVS)的危险因素,为防治SAH后CVS提供依据。方法  选择2018年5月至2020年5月许昌市中心医院收治的96例SAH患者为研究对象,依据是否发生CVS将患者分为SAH组(n=50)和SAH+CVS组(n=46),分析SAH患者发生CVS的危险因素。结果 单因素分析结果显示,年龄、Fisher分级、Hunt-Hess分级、意识障碍、吸烟、高血压、白细胞计数、血钙水平与SAH患者发生CVS有关(P<0.05),而性别、饮酒、高血糖与SAH患者发生CVS无关(P>0.05)。Logistic回归分析显示,年龄>55岁、Fisher分级 Ⅳ 级、Hunt-Hess分级>Ⅲ级、意识障碍、高血压、白细胞计数>15×109 L-1、血钙<2.2 mmol·L-1为SAH患者发生CVS的独立危险因素(P<0.05)。结论 SAH后CVS具有较高的发生率,年龄较大、Fisher分级和Hunt-Hess分级高、意识障碍、高血压、白细胞计数高、血钙水平低为SAH患者发生CVS的独立危险因素,临床应针对CVS发生的危险因素制定相应的防治措施,以降低SAH患者CVS发生率,改善患者预后。
Abstract:
Objective To investigate the risk factors for cerebral vasospasm (CVS) in patients with subarachnoid hemorrhage (SAH),so as to provide evidence for the prevention and treatment of CVS after SAH.Methods A total of 96 SAH patients admitted to Xuchang Central Hospital from May 2018 to May 2020 were selected as the research subjects,and the patients were divided into SAH group (n=50) and SAH+CVS group (n=46) according to whether CVS occurred or not,and the risk factors for CVS in SAH patients were analyzed.Results The univariate analysis showed that the age,Fisher classification,Hunt-Hess classification,consciousness disorders,smoking,hypertension,white blood cell count,and blood calcium level were associated with the occurrence of CVS in SAH patients (P<0.05),while the gender,alcohol drinking and hyperglycemia were not associated with the occurrence of CVS in SAH patients(P>0.05).Logistic regression analysis showed that the age>55 years old,Fisher grade Ⅳ,Hunt-Hess classification>Ⅲ,consciousness disorders,hypertension,white blood cell count>15×109 L-1,blood calcium <2.2 mmol·L-1 were the independent risk factors for CVS in SAH patients (P<0.05).Conclusion The incidence of CVS is higher after SAH.The older age,higher Fisher and Hunt-Hess classification,consciousness disorders,hypertension,high white blood cell count and low blood calcium level are the independent risk factors for CVS in SAH patients.The corresponding prevention and treatment measures should be formulated according to the risk factors of CVS,so as to reduce the incidence of CVS and improve the prognosis of SAH patients.

参考文献/References:

[1] 齐猛,曲鑫,徐跃峤,等.老年重症动脉瘤性蛛网膜下腔出血患者预后的影响因素分析[J].中国脑血管病杂志,2020,17(1):11-16.
QI M,QU X,XU Y Q,et al.Analysis of prognostic factors on elderly patients with severe aneurysmal subarachnoid hemorrhage[J].Chin J Cerebrovasc Dis,2020,17(1):11-16.
[2] KOMATSUZAKI M,TAKASUSUKI T,KIMURA Y,et al.Assessment of the ECG T-wave in patients with subarachnoid hemorrhage[J].J Neurosurg Anesthesiol,2021,33(1):58-64.
[3] 张振,张恒柱,李育平,等.全身炎症反应指数与动脉瘤性蛛网膜下腔出血术后症状性脑血管痉挛的关系及Nomogram预测模型的建立[J].实用临床医药杂志,2020,24(10):36-40.
ZHANG Z,ZHANG H Z,LI Y P,et al.Relationship between systemic inflammation response index and symptomatic cerebral vasospasm after aneurismal subarachnoid hemorrhage as well as construction of a nomogram predictive model[J].J Clin Med Pract,2020,24(10):36-40.
[4] 菅超,陈维亮.磁共振弥散张量成像及动脉自旋标记成像在缺血性脑梗死诊断及分期中的应用价值[J].新乡医学院学报,2020,37(7):648-651.
JIAN C,CHEN W L.Application value of magnetic resonance diffusion tensor imaging and arterial spin labeling in the diagnosis and staging of cerebral ischemic infarction[J].J Xinxiang Med Univ,2020,37(7):648-651.
[5] 谭占国,黄圣明.蛛网膜下腔出血后迟发脑血管痉挛诊治新进展[J].中国临床神经外科杂志,2019,24(8):505-506,510.
TAN Z G,HUANG S M.New progress in diagnosis and treatment of delayed cerebral vasospasm after subarachnoid hemorrhage[J].Chin J Clin Neurosurg,2019,24(8):505-506,510.
[6] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组,中华医学会神经病学分会神经血管介入协作组.中国蛛网膜下腔出血诊治指南2019[J].中华神经科杂志,2019,52(12):1006-1021.
CHINESE SOCIETY OF NEUROLOGY,CHINESE STROKE SOCIETY,NEUROVASCULAR GROUP OF CHINESE SOCIETY OF NEUROLOGY.Chinese guidelines for diagnosis and treatment of subarachnoid hemorrhage 2019[J].Chin J Neurol,2019,52(12):1006-1021.
[7] 中华医学会神经外科学分会.脑血管痉挛防治神经外科专家共识[J].中华医学杂志,2008,88(31):2161-2165.
NEUROSURGERY BRANCH OF CHINESE MEDICAL ASSOCIATION.Neurosurgery expert consensus:treatment and prevention of cerebral vasospasm[J].Chin J Stroke,2008,88(31):2161-2165.
[8] DITZ C,LEPPERT J,NEUMANN A,et al.Cerebral vasospasm after spontaneous subarachnoid hemorrhage:angiographic pattern and its impact on the clinical course[J].World Neurosurg,2020,138:e913-e921.
[9] JOVANOVIC' I,NEMIR J,GARDIJAN D,et al.Transient acute hydrocephalus after aneurysmal subarachnoid hemorrhage and aneurysm embolization:a single-center experience[J].Neuroradiology,2021,63(12):2111-2119.
[10] ARIYADA K,SHIBAHASHI K,FUJIKA N,et al.Posterior communicating artery hypoplasia:a risk factor for vertebral artery dissection causing subarachnoid hemorrhage[J].J Stroke Cerebrovasc Dis,2021,31(2):106224.
[11] 黄喆,董宇为.动脉瘤破裂位置对蛛网膜下腔出血后血凝块厚度及脑血管痉挛发生的影响[J].神经损伤与功能重建,2020,15(10):603-604,611.
HUANG Z,DONG Y W.Effects of aneurysm rupture location on blood clot thickness and cerebral vasospasm after subarachnoid hemorrhage[J].Neural Injury Funct Reconstr,2020,15(10):603-604,611.
[12] MIJITI M,MIJITI P,AXIER A,et al.Incidence and predictors of angiographic vasospasm,symptomatic vasospasm and cerebral infarction in Chinese patients with aneurysmal subarachnoid hemorrhage[J].PLoS One.2016,11(12):e0168657.
[13] RITZENTHALER T,GOBERT F,BOUCHIER B,et al.Amount of blood during the subacute phase and clot clearance rate as prognostic factors for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage[J].J Clin Neurosci,2021,87:74-79.
[14] 戴永建,罗俊杰,刘岳.蛛网膜下腔出血致脑血管痉挛的相关影响因素研究[J].现代中西医结合杂志,2015,24(6):646-648.
DAI Y J,LUO J J,LIU Y.Study on the related influencing factors of cerebral vasospasm caused by subarachnoid hemorrhage[J].Mod J Integr Tradit Chin West Med,2015,24(6):646-648.
[15] 方佳,董秋艳,胡晨浩,等.尼莫地平联合腰椎穿刺脑脊液置换对动脉瘤性蛛网膜下腔出血后脑血管痉挛患者血红蛋白浓度、Toll样受体4表达水平和脑血管痉挛的影响[J].国际脑血管病杂志,2019,27(9):685-690.
FANG J,DONG Q Y,HU C H,et al.Effect of nimodipine combined with cerebrospinal fluid replacement by lumbar puncture on hemoglobin concentration,Toll-like receptor 4 expression levels and cerebral vasospasm in patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage[J].Int J Cerebrovasc Dis,2019,27(9):685-690.
[16] LIU H H,SCHWARTING J,TERPOLILLI N A,et al.Scavenging free iron reduces arteriolar microvasospasms after experimental subarachnoid hemorrhage[J].Stroke,2021,52(12):4033-4042.

相似文献/References:

[1]李雁恩,原立新.168 [J].新乡医学院学报,1992,9(02):168.
[2]毛向莹 李彤 魏树亭.大剂量地塞米松鞘内注射治疗蛛网膜下腔出血性头痛[J].新乡医学院学报,2002,19(01):019.
[3]朱佩文。,杨瑞民,张铭秋.蛛网膜下腔出血临床与数字减影血管造影术分析[J].新乡医学院学报,2003,20(05):363.
[4]单艳华,张勇刚.不等量脑脊液置换并鞘内注射尿激酶治疗蛛网膜下腔出血116例 [J].新乡医学院学报,2006,23(03):000.
[5]李爱女.脑脊液置换术治疗蛛网膜下腔出血30 例[J].新乡医学院学报,2006,23(05):519.
[6]万琦文,郭荣增,张亦鹏,等.纳美芬与尼莫地平治疗儿童急性外伤性蛛网膜下腔出血后脑血管痉挛疗效比较[J].新乡医学院学报,2023,40(11):1065.[doi:10.7683/xxyxyxb.2023.11.011]
 WAN Qiwen,GUO Rongzeng,ZHANG Yipeng,et al.Comparison of the clinical efficacy of nalmefene and nimodipine in the treatment of cerebral vasospasm of children with acute traumatic subarachnoid hemorrhage[J].Journal of Xinxiang Medical University,2023,40(5):1065.[doi:10.7683/xxyxyxb.2023.11.011]

更新日期/Last Update: 2022-05-05