脑脊液红细胞数与动脉瘤性蛛网膜下腔出血术后脑血管痉挛的相关性研究
Study on the Relationship between Red Blood Cell Count in Cerebrospinal Fluid and Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage
DOI: 10.12677/acm.2025.15113240, PDF,   
作者: 武 昊*, 高 军#：首都医科大学宣武医院济南医院，山东 济南；张明坤：山东第一医科大学第一附属医院神经外科，山东 济南
关键词: 红细胞；动脉瘤性蛛网膜下腔出血；脑血管痉挛；氧合血红蛋白；脑脊液引流；Red Blood Cells； Aneurysmal Subarachnoid Hemorrhage； Cerebral Vasospasm； Oxygenated Hemoglobin； Cerebrospinal Fluid Drainage
摘要: 目的：分析脑脊液中红细胞数与动脉瘤性蛛网膜下腔出血(ASAH)患者术后发生脑血管痉挛(CVS)的相关性，以此指导治疗。方法：回顾性分析山东省千佛山医院2018.09~2021.09住院治疗的205例ASAH患者，根据术后是否发生CVS分为CVS组与非CVS组，分析患者入院时的基本情况、实验室检查结果、影像学检查结果、动脉瘤治疗方法与术后脑血管痉挛的关系，进行单因素分析，并将单因素分析中P < 0.1的变量纳入Logistic回归，分析ASAH患者术后发生CVS的危险因素。结果：共纳入205例研究对象，59例术后发生脑血管痉挛。单因素分析提示脑脊液红细胞数与患者术后出现CVS显著相关(P < 0.001)，多因素分析在调整了年龄、Hunt-Hess分级、GCS评分混杂作用后，发现脑脊液红细胞数量与患者在术后发生CVS显著相关(P < 0.001)。结论：脑脊液中红细胞的数量是ASAH患者术后发生CVS的独立危险因素，说明实施腰椎穿刺或腰大池引流等措施快速减少脑脊液中红细胞数量，可能是预防CVS有效的方法。
Abstract: Objective: To analyze the relationship between the number of red blood cells in cerebrospinal fluid (CSF) and cerebral vasospasm (CVS) after aneurysmal subarachnoid hemorrhage (ASAH) and to guide the treatment. Methods: A retrospective analysis was conducted on 205 patients with aneurysmal vasospasm (ASAH) hospitalized at Shandong Qianfoshan Hospital from September 2018 to September 2021. Patients were divided into a CVS group and a non-CVS group based on whether postoperative CVS occurred. The relationship between patients’ basic information at admission, laboratory test results, imaging results, aneurysm treatment methods, and postoperative cerebral vasospasm was analyzed. Univariate analysis was performed, and variables with P < 0.1 in the univariate analysis were included in logistic regression to analyze the risk factors for postoperative CVS in ASAH patients. Results: A total of 205 subjects were included, of which 59 cases developed cerebral vasospasm after the operation. Single factor analysis showed that the number of red blood cells in cerebrospinal fluid was significantly correlated with CVS (P < 0.001). After adjustment for age, Hunt-Hess scale and GCS score, multiple factors logistic regression analysis showed that the number of red blood cells in cerebrospinal fluid was significantly correlated with CVS (P < 0.001). Conclusion: The number of red blood cells in cerebrospinal fluid is an independent risk factor for CVS after ASAH, indicating that lumbar puncture or lumbar cistern drainage and other measures to reduce the number of red blood cells in cerebrospinal fluid may be effective methods to prevent CVS.
文章引用：武昊, 张明坤, 高军. 脑脊液红细胞数与动脉瘤性蛛网膜下腔出血术后脑血管痉挛的相关性研究[J]. 临床医学进展, 2025, 15(11): 1431-1437. https://doi.org/10.12677/acm.2025.15113240

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