CAJ | 학술논문

目的：探讨动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage，aSAH）后脑血管痉挛（ce?rebral vasospasm,CVS）相关危险因素，为其临床预防及治疗提供依据。方法回顾性分析2012年3月至2014年3月收治的255例aSAH患者临床资料，主要包括分析年龄、性别、民族、高血压病史、吸烟史、动脉瘤的部位、改良Fisher分级、入院时Hunt-Hess分级、小剂量尼莫同、脱水剂、白细胞计数、血糖、血脂、血钙水平、血小板计数等,并对上述因素与CVS的发生进行单因素分析和多因素Logistic回归分析。结果255例aSAH患者中，共出现CVS患者73例，aSAH后CVS的发生率为28.6%；单因素分析提示，高血压史、吸烟史、改良Fisher分级、入院时Hunt-Hess分级、小剂量尼莫同、白细胞计数及血糖差异有统计学意义（P﹤0.05）。Logistic回归分析提示，高血压病史、吸烟史、改良Fisher分级、入院时Hunt-Hess分级、小剂量尼莫同及白细胞计数是aSAH后CVS的危险因素（P﹤0.05）。结论高血压病史、吸烟史、改良Fisher分级高、入院时Hunt-Hess分级高是aSAH后CVS的独立危险因素，小剂量尼莫同是其保护因素，白细胞计数是预测因子，故临床应加强危险因素的控制。
목적：탐토동맥류성주망막하강출혈（aneurysmal subarachnoid hemorrhage，aSAH）후뇌혈관경련（ce?rebral vasospasm,CVS）상관위험인소，위기림상예방급치료제공의거。방법회고성분석2012년3월지2014년3월수치적255례aSAH환자림상자료，주요포괄분석년령、성별、민족、고혈압병사、흡연사、동맥류적부위、개량Fisher분급、입원시Hunt-Hess분급、소제량니막동、탈수제、백세포계수、혈당、혈지、혈개수평、혈소판계수등,병대상술인소여CVS적발생진행단인소분석화다인소Logistic회귀분석。결과255례aSAH환자중，공출현CVS환자73례，aSAH후CVS적발생솔위28.6%；단인소분석제시，고혈압사、흡연사、개량Fisher분급、입원시Hunt-Hess분급、소제량니막동、백세포계수급혈당차이유통계학의의（P﹤0.05）。Logistic회귀분석제시，고혈압병사、흡연사、개량Fisher분급、입원시Hunt-Hess분급、소제량니막동급백세포계수시aSAH후CVS적위험인소（P﹤0.05）。결론고혈압병사、흡연사、개량Fisher분급고、입원시Hunt-Hess분급고시aSAH후CVS적독립위험인소，소제량니막동시기보호인소，백세포계수시예측인자，고림상응가강위험인소적공제。
Objective To investigate the risk factors of aneurysmal subarachnoid hemorrhage (aneuryismal sub?arachnoid hemorrhage, aSAH) vasospasm (cerebral vasospasm, CVS) and provide the basis for the clinical prevention and treatment of CVS. Methods A retrospective analysis of clinical data was conducted on 255 cases aSAH patients receiving treatment between March 2012 and March 2014 in First Affiliated Hospital of Xinjiang Medical University Department of Neurosurgery, s treated. The clinical data included admission age, gender, ethnicity, history of hypertension, smoking his?tory, arterial tumor site, improved Fisher grading, admission Hunt-Hess grade, the dosage of Nimodipine, dehydrating agent, white blood cell count, blood glucose, blood lipids, blood calcium levels, platelet count. Univariate analysis and multivariate Logistic retrospective analysis were used to analyze the association between above-mentioned factors and the occurrence of CVS. Results A total of 73 cases developed CVS after aSAH and incidence rate of CVS was 28.6%. Uni?variate analysis showed that there were significant differences between patients with and without CVS in history of hyper? tension, smoking history, improved Fisher grade, admission Hunt-Hess grade, small doses of nimodipine, white blood cell count and blood glucose (P<0.05). The Logistic regression analysis showed that the history of hypertension, smoking history, improved Fisher grade, admission Hunt-Hess grade, a small dose of Nimodipine and white blood cell count were risk factors of CVS after aSAH (P<0.05). Conclusions the History of hypertension, smoking history, improved high Fish?er grade, high admission Hunt-Hess grade are independent risk factors of CVS after aSAH. A small dose of Nimodipine is a protective factor while increase in white blood cell count is a risk predictor, which should be controlled by enhancing clinical prevention.