论文部分内容阅读
目的对脑动脉瘤术后患者血管痉挛发生的影响因素进行分析,寻找保护因素。方法选取2004年10月至2006年3月就治于苏州大学附属第一医院神经外科的动脉瘤性蛛网膜下腔出血患者共计82例,随机进入依达拉奉治疗组(n=41)和常规治疗组(n=41)。常规治疗组于发病后3 d内手术夹闭动脉瘤,并尽可能清除基底池的血块;依达拉奉治疗组在确诊后即给予依达拉奉30 mg,静滴,2次/d,共14 d。其余治疗同常规治疗组。详细观察并记录患者每天的病情变化、Glasgow评分和入院时的Fisher分级、Humter’s分级及术后患者症状性血管痉挛的发生情况。对所有患者症状性血管痉挛的发生情况按患者的年龄,入院时的Fisher分级、Hunter’s分级、依达拉奉治疗的应用、患者的性别等进行Logistic多因素逐步回归分析。结果两组症状性血管痉挛发生率分别为:依达拉奉组14.63%,常规治疗组36.59%。Logistic多因素逐步回归分析显示入院时的Fisher分级、Hunter’s分级和依达拉奉治疗等变量进入模型(P<0.05)。其中患者入院时的Fisher分级、Hunter’s分级的OR值(多变量调整后的优势比)分别为6.55和5.62,均大于1,提示这两者均为症状性脑血管痉挛发生的危险因素;而依达拉奉的OR值为0.11<1,提示其为症状性血管痉挛发生的保护因素。结论多个因素影响脑动脉瘤术后症状性血管痉挛的发生,其中患者入院时的Fisher分级、Hunter’s分级为危险因素,分级越高,越容易发生血管痉挛,而依达拉奉治疗为一保护因素,与常规治疗联合应用可更好地预防症状性血管痉挛的发生。
Objective To analyze the influential factors of vasospasm in patients with cerebral aneurysm after surgery and find out the protective factors. Methods A total of 82 patients with aneurysmal subarachnoid hemorrhage who underwent neurosurgery in the First Affiliated Hospital of Soochow University from October 2004 to March 2006 were selected and randomly assigned to receive edaravone (n = 41) and Routine treatment group (n = 41). In the conventional treatment group, the aneurysms were surgically occluded within 3 days of onset and the clot of basilar pool was cleared as much as possible. Edaravone 30 mg, intravenous infusion, 2 times / d, A total of 14 d. The remaining treatment with the conventional treatment group. Detailed observation and record of the patients daily changes in condition, Glasgow score and admission Fisher classification, Humter’s classification and postoperative patients with symptomatic vasospasm. The incidence of symptomatic vasospasm in all patients was analyzed by stepwise Logistic regression with multiple factors according to patient’s age, Fisher’s grade at admission, Hunter’s classification, edaravone treatment, patient’s gender and so on. Results The incidence of symptomatic vasospasm in both groups was 14.63% in the edaravone group and 36.59% in the conventional treatment group. Logistic regression analysis showed that Fisher’s classification, Hunter’s classification and edaravone at admission were included in the model (P <0.05). Among them, the Fisher classification at admission, Hunter’s classification OR (multivariate adjusted odds ratio) were 6.55 and 5.62, respectively, which were greater than 1, suggesting that both were risk factors for symptomatic cerebral vasospasm; The OR of dalarpane was 0.11 <1, suggesting that it is a protective factor of symptomatic vasospasm. Conclusions Several factors affect the occurrence of symptomatic vasospasm after cerebral aneurysm surgery. Among them, Fisher’s classification and Hunter’s classification at admission are risk factors. The higher the grade, the more prone to vasospasm. Edaravone treatment is a protection Factors, combined with conventional treatment can better prevent the occurrence of symptomatic vasospasm.