自发性蛛网膜下腔出血并发急性脑积水的相关因素分析

Analysis of the Related Factors of Acute Hydrocephalus Complicated with Spontaneous Subarachnoid Hemorrhage

摘要: 目的：探讨自发性蛛网膜下腔出血后并发急性脑积水的相关危险因素。方法：选取西安市中心医院神经外科收治的162例蛛网膜下腔出血的患者作为研究对象，统计患者的年龄、性别、饮酒史、吸烟史、高血压病史、糖尿病史、入院时是否昏迷、入院时是否呕吐、GCS评分、脑室出血、早期腰大池引流术、早期锥颅置管引流术、颅内动脉瘤等相关资料，本研究采用二元Logistic回归模型，深入剖析自发性蛛网膜下腔出血(SAH)患者并发急性脑积水(AHC)的相关危险因素。P < 0.05为差异有统计学意义。结果：发生急性脑积水的患者平均年龄大于未患急性脑积水患者平均年龄；女性患急性脑积水的比例大于男性；无饮酒史的患者患急性脑积水的比率大于有饮酒史的患者；不吸烟的患者患急性脑积水的比例大于吸烟患者；有高血压病史的患者患急性脑积水的比例大于无高血压病史的患者；有糖尿病病史的患者患急性脑积水的比例大于无糖尿病病史的患者；入院时昏迷的患者发生急性脑积水的概率高；入院时呕吐的患者发生急性脑积水的概率高；GCS评分 ≥ 8分的患者患急性脑积水的概率更高；早期脑室积血的患者患急性脑积水的概率更高；早期未接受锥颅置管引流术治疗的患者患急性脑积水的比例更高。早期腰大池引流术、糖尿病史无统计学意义，P > 0.05。是否有动脉瘤与急性脑积水的发生无统计学意义，P = 0.663。Hunt-Hess分级更高的患者发生急性脑积水的比例Hunt-Hess分级低的患者；患急性脑积水的患者动脉瘤直径大于未患急性脑积水的患者；动脉瘤位置、是否接受动脉瘤栓塞术无统计学意义，P > 0.05。多因素Logistic回归分析显示，年龄、GCS < 8分、脑室积血、入院时呕吐、入院时昏迷是自发性蛛网膜下腔出血患者并发急性脑积水的危险因素。讨论：自发性蛛网膜下腔出血患者并发急性脑积水的相关因素为年龄、GCS < 8分、脑室积血、入院时呕吐、入院时昏迷，动脉瘤性蛛网膜下腔出血患者并发急性脑积水的相关因素为动脉瘤的大小、Hunt-Hess分级。

Abstract: Objective: To explore the associated risk factors for the development of acute hydrocephalus following spontaneous subarachnoid hemorrhage. Methods: A total of 162 patients with spontaneous subarachnoid hemorrhage admitted to the Department of Neurosurgery at Xi’an Central Hospital were selected as the subjects of this study. Data including patient age, gender, drinking history, smoking history, history of hypertension, history of diabetes, coma on admission, vomiting on admission, GCS score, intracerebral hemorrhage, early ventricular hemorrhage, early lumbar puncture, early placement of external ventricular drainage, intracranial aneurysm, and other relevant information were collected. Multifactor Logistic regression analysis was used to assess the associated risk factors for the development of acute hydrocephalus in patients with spontaneous subarachnoid hemorrhage. A P-value of less than 0.05 was considered to indicate statistical significance. Results: Patients who developed acute hydrocephalus had a higher average age than those who did not; the proportion of females with acute hydrocephalus was greater than that of males; the rate of acute hydrocephalus in patients without a history of alcohol consumption was higher than those with a history of alcohol consumption; the proportion of patients who did not smoke and developed acute hydrocephalus was greater than those who smoked; patients with a history of hypertension had a higher proportion of acute hydrocephalus than those without a history of hypertension; the proportion of patients with a history of diabetes developing acute hydrocephalus was greater than those without a history of diabetes; patients who were comatose on admission had a higher probability of developing acute hydrocephalus; patients who vomited on admission had a higher likelihood of developing acute hydrocephalus; patients with a GCS score of 8 or higher had a higher probability of developing acute hydrocephalus; patients with early ventricular hemorrhage had a higher probability of developing acute hydrocephalus; the proportion of patients who did not receive early placement of external ventricular drainage and developed acute hydrocephalus was higher. Early lumbar puncture, a history of diabetes, did not show statistical significance, P > 0.05. The presence of an aneurysm was not statistically significant in relation to the occurrence of acute hydrocephalus, P = 0.663. Patients with a higher Hunt-Hess grade had a higher proportion of acute hydrocephalus; patients with acute hydrocephalus had a larger aneurysm diameter than those without acute hydrocephalus; the location of the aneurysm, and whether they received aneurysm occlusion surgery did not show statistical significance, P > 0.05. Multivariate Logistic regression analysis showed that age, GCS score less than 8, ventricular hemorrhage, vomiting on admission, and coma on admission were risk factors for the development of acute hydrocephalus in patients with spontaneous subarachnoid hemorrhage. Discussion: The associated risk factors for the development of acute hydrocephalus in patients with spontaneous subarachnoid hemorrhage include age, GCS score less than 1, ventricular hemorrhage, vomiting on admission, and coma on admission. For aneurysmal subarachnoid hemorrhage patients, the associated risk factors for the development of acute hydrocephalus include the size and Hunt-Hess grade.