动脉瘤性蛛网膜下腔出血介入治疗后慢性意识障碍的危险因素
韩 超 王如海 张 成 杨东升 于 强 胡海成
阜阳师范大学附属第二医院，安徽 阜阳 236000
通信作者：胡海成
【摘要】 目的 探讨动脉瘤性蛛网膜下腔出血(aSAH)患者经介入治疗后出现慢性意识障碍（pDoC）的术前影响因素。方法 分析 2019-05—2022-03 阜阳师范大学附属第二医院治疗的 102 例动脉瘤破裂蛛网膜下腔出血患者的术前临床资料。根据 aSAH 患者介入治疗后 28 d 意识情况分为 pDoC 组和非 pDoC 组，通过单因素和多因素 Logistic 回归分析介入术后 SAH 患者 pDoC 形成的危险因素。采用受试者工作特征曲线（ROC）分析影响因素预测 pDoC 的能力。结果 单因素分析提示，术前血清葡萄糖和钾的比值、白细胞计数、血糖、Hunt-Hess 分级、急性脑积水、颅内血肿、脑出血破入脑室等是 pDoC 形成的可能影响因素（P<0.05）。多因素 Logistic 回归分析显示，Hunt-Hess 分级、急性脑积水、颅内血肿等为 pDoC 的独立危险因素（P<0.05）。以 Hunt-Hess 分级等危险因素为检验变量，以 pDoC 为状态变量绘制 aSAH 受试者特征工作曲线 ，术前 Hunt-Hess 分级的 AUC 为 0.895（95% CI：0.818~0.947，P<0.001），约登指数为0.4893，敏感度76.20%，特异度 91.4%。急性脑积水、颅内血肿、Hunt-Hess 分级联合预测预后的 AUC 为 0.924（95% CI：0.855~0.967，P<0.001），敏感度 85.71%，特异度 91.36%。结论 aSAH 患者较高级别的 Hunt-Hess 分级、合并急性脑积水、颅内血肿等可能与术后pDoC有关，3种危险因素同时发生可能造成pDoC机会更高。
【关键词】 脑动脉瘤破裂；蛛网膜下腔出血；介入治疗；慢性意识障碍；影响因素
【中图分类号】 R743.35 【文献标识码】 A 【文章编号】 1673-5110 （2022） 07-0813-06
基金项目：安徽省科技重大专项项目（编号：201903a07020006）
DOI：10.12083/SYSJ.220688
Predictors of prolonged disorders of consciousness after intervention for aneurysmal subarachnoid hemorrhage
HAN Chao，WANG Ruhai，ZHANG Cheng，YANG Dongsheng，YU Qiang，HU Haicheng
The Second Affiliated Hospital of Fuyang Normal University，Fuyang 236000，China
Corresponding author：HU Haicheng
【Abstract】 Objective To investigate the preoperative risk factors of prolonged disorders of consciousness (pDoC) in patients with aneurysmal subarachnoid hemorrhage after interventional therapy. Methods The preoperative clinical data of 102 patients with ruptured subarachnoid hemorrhage aneurysm from May 2019 to March 2022 were reviewed. The patients with aneurysmal subarachnoid hemorrhage were divided into pDoC group and non-pDoC group according to their consciousness 28 days after interventional therapy. The risk factors of pDoC formation were revealed by univariate and multivariate Logistic regression analysis. Receiver characteristic curve （ROC）was used to analyze the ability to predict pDoC. Results According to the results of univariate analysis，the ratio of serum glucose and potassium，white blood cell count，blood glucose，Hunt-Hess grade，acute hydrocephalus，intracerebral hematoma，and rupture of intracerebral hemorrhage into ventricles were the possible influencing factors of pDoC（P<0.05）. Multiple Logistic regression factors analysis showed that Hunt-Hess grade，acute hydrocephalus and intracerebral hematoma were independent risk factors of pDoC （P<0.05）. Risk factors such as Hunt-Hess grade were used as test variables，and prognostic pDoC was used as state variable to draw ROC. The AUC of Hunt-Hess grade classification was 0.895（95% CI：0.818-0.947，P<0.001），the Yorden index was 0.4893，the sensitivity was 76.20%，the specificity was 91.4%. The AUC of combined of acute hydrocephalus，intracranial hematoma and Hunt-Hess lassification predicts prognosis was 0.924（95% CI：0.855-0.967，P<0.001），sensitivity was 85.71%，specificity was 91.36%. Conclusion The higher Hunt-Hess grade，acute hydrocephalus and intracranial hematoma in patients with aSAH may be related to pDoC，and more risk factors may result in higher chance of pDoC.
【Key words】 Ruptured cerebral aneurysm；Subarachnoid hemorrhage；Interventional therapy；Prolonged disorders of consciousness；Influencing factors
