CAJ | 학술논문

目的：探讨动脉瘤性蛛网膜下腔出血后患者症状性脑血管痉挛的相关因素。方法本研究选取71例确诊为动脉瘤性蛛网膜下腔出血的患者为研究对象，在72小时之内行TCD，获得颅内大脑中动脉流速（MCAV）、颈内动脉血流速度、Lindegaard比值、颅内血管痉挛指数（VI）；并同时收集所有患者临床特征：年龄，性别，Hunt-Hess分级，CT Fisher分级，WBC计数（WBC），治疗方法（弹簧圈栓塞，外科夹闭或保守治疗），吸烟史，高血压病史；同时观察患者有无症状性脑血管痉挛发生。用SPSS统计学软件进行统计学分析。结果21例（29．6%）发生症状性脑血管痉挛，单因素分析结果表明：MCAV、Lindegarrd率、VI、WBC计数（WBC）、Hunt-Hess分级、Fisher分级6个因素与是否发生症状性脑血管痉挛明显相关；纳入多因素Logistic回归分析，仅有CT Fisher分级，MCA流速，痉挛指数进入方程。可见对于诊断症状性血管痉挛，最好的多变量模型是选用CT Fisher分级，MCA流速，痉挛指数为变量。结论 MCAV、Lindegarrd率、VI、WBC计数、Hunt-Hess分级、Fisher分级6个因素是发生症状性脑血管痉挛的最重要影响因素。
목적：탐토동맥류성주망막하강출혈후환자증상성뇌혈관경련적상관인소。방법본연구선취71례학진위동맥류성주망막하강출혈적환자위연구대상，재72소시지내행TCD，획득로내대뇌중동맥류속（MCAV）、경내동맥혈류속도、Lindegaard비치、로내혈관경련지수（VI）；병동시수집소유환자림상특정：년령，성별，Hunt-Hess분급，CT Fisher분급，WBC계수（WBC），치료방법（탄황권전새，외과협폐혹보수치료），흡연사，고혈압병사；동시관찰환자유무증상성뇌혈관경련발생。용SPSS통계학연건진행통계학분석。결과21례（29．6%）발생증상성뇌혈관경련，단인소분석결과표명：MCAV、Lindegarrd솔、VI、WBC계수（WBC）、Hunt-Hess분급、Fisher분급6개인소여시부발생증상성뇌혈관경련명현상관；납입다인소Logistic회귀분석，부유CT Fisher분급，MCA류속，경련지수진입방정。가견대우진단증상성혈관경련，최호적다변량모형시선용CT Fisher분급，MCA류속，경련지수위변량。결론 MCAV、Lindegarrd솔、VI、WBC계수、Hunt-Hess분급、Fisher분급6개인소시발생증상성뇌혈관경련적최중요영향인소。
Objective To explore the relevant factors of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage. Methods 71 patients with aneurysmal SAH was demonstrated by computed tomography, and in whom one or more intracranial aneurysms had been diagnosed, un-derwent transcranial doppler (TCD) in 72h to calculate the Lindegaard ratios, middle cerebral artery velocity(MCAV), Internal carotid artery blood flow velocity, spasm indexes. The data of age, sex, Hunt and Hess degree, Fisher grade, treatment(coil embolization, surgical clip occlusion, or conservative treatment), smoking history, and hypertension history were collected. Logistic regression was used to evaluate the possible predictive factors. Results In 21 patients (29.6%) symptomatic vasospasm was diagnosed. Logistic analysis indicated that MCAV, Lindegaard ratios and spasm indexes, Hunt-Hess degree, Fisher grade, WBC were the independent risk factors. The selected model for estimation of clinical vasospasm included Fisher grade, MCAV, and spasm index. Conclusion MCAV, Lindegaard ratios and spasm indexes, Hunt-Hess degree, Fisher grade, WBC were the independent risk factors affecting the symptomatic vasospasm.