摘要
目的 探讨影响动脉瘤性蛛网膜下腔出血(aSAH)患者短期生存预后的相关因素.方法 回顾性分析2019年6月至2022年3月潍坊市人民医院神经外科诊治的407例aSAH患者的临床资料、影像学资料以及生存预后等.采用log-rank检验对aSAH患者进行生存预后的单因素分析,将P＜0.05的变量纳入多因素Cox比例风险回归模型进行生存预后的多因素分析.结果 407例患者的随访时间[M(Q1,Q3)]为9.2(6.5,18.7)个月.至末次随访,死亡121例(29.7％).单因素分析结果显示,男性、年龄≥60岁、有吸烟史、饮酒史、原发性高血压病史、缺血性卒中史、入院格拉斯哥昏迷评分(GCS)为3～8分、Hunt-Hess分级Ⅳ～Ⅴ级、改良Fisher量表评分3～4分、并发脑血管痉挛以及并发肺部感染的患者生存率较低,动脉瘤为囊状、采用血管内栓塞治疗的患者生存率较高,差异均具有统计学意义(均P＜0.05).多因素Cox比例风险回归模型分析结果显示,年龄≥60岁(HR=2.14,95％CI:1.44～3.19,P＜0.001)、有原发性高血压病史(HR=1.83,95％CI:1.19～2.82,P=0.006)、缺血性卒中史(HR=1.71,95％CI:1.02～2.87,P=0.043)、入院 Hunt-Hess 分级Ⅳ～Ⅴ级(HR=2.45,95％CI:1.25～4.79,P=0.009)、改良 Fisher 量表评分3～4 分(HR=1.80,95％CI:1.11～2.90,P=0.017)、并发脑血管痉挛(HR=2.59,95％CI:1.58～4.25,P＜0.001)、并发肺部感染(HR=1.72,95％CI:1.02～2.90,P=0.042)均是影响患者短期生存预后的危险因素,而GCS 13～15分(HR=0.48,95％CI:0.25～0.93,P=0.030)和血管内栓塞治疗(HR=0.55,95％CI:0.31～0.97,P=0.039)是影响患者短期生存预后的保护因素.结论 年龄≥60岁、有原发性高血压病史、缺血性卒中史、入院Hunt-Hess分级Ⅳ～Ⅴ级、改良Fisher量表评分3～4分、并发脑血管痉挛、肺部感染的aSAH患者短期死亡风险增加,而入院GCS为13～15分、采用血管内栓塞治疗的aSAH患者短期死亡风险相对较低.
Abstract
Objective To investigate the factors associated with short-term survival in patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods The clinical data of 407 patients with aS AH treated by the Department of Neurosurgery of Weifang People's Hospital from June 2019 to March 2022 were retrospectively analyzed,including patients'clinical data,imaging data and survival outcomes.The log-rank test was used for univariate analysis of survival outcome of aSAH patients,and variables with P＜0.05 were included in the multivariate Cox proportional risk regression model for multivariate analysis of survival.Results The follow-up time[median(Q,,Q3)]for 407 patients was 9.2(6.5,18.7)months.By the final follow-up,there were 121 deaths(29.7％).The results of univariate analysis showed that patients who were males,≥60 years of age,had a history of smoking,alcohol consumption,history of primary hypertension,history of ischemic stroke,Glasgow Coma Score(GCS)on admission of 3-8,Hunt-Hess classification Ⅳ-Ⅴ,modified Fisher Scale score of 3-4,concomitant cerebral vasospasm,and concomitant pulmonary infections had lower survival rate,and those with aneurysms that were saccular and treated with endovascular embolization had higher survival rate,and the differences were statistically significant(all P＜0.05).Analysis of the multivariate Cox proportional risk regression model showed that age ≥60 years(HR=2.14,95％CI:1.44-3.19,P＜0.001),history of primary hypertension(HR=1.83,95％CI:1.19-2.82,P=0.006),history of ischemic stroke(HR=1.71,95％CI:1.02-2.87,P=0.043),Hunt-Hess classification Ⅳ-Ⅴ at admission(HR=2.45,95％CI:1.25-4.79,P=0.009),modified Fisher Scale score of 3-4(HR=1.80,95％CI:1.11-2.90,P=0.017),and concurrent cerebral vasospasm(HR=2.59,95％CI:1.58-4.25,P＜0.001),and concomitant pulmonary infection(HR=1.72,95％CI:1.02-2.90,P=0.042)were all risk factors affecting patients'short-term survival,whereas a GCS score of 13-15(HR=0.48,95％CI:0.25-0.93,P=0.030)and endovascular embolization therapy(HR=0.55,95％CI:0.31-0.97,P=0.039)were protective factors affecting patients'short-term survival.Conclusions Patients with aSAH who were ≥60 years of age,had a history of primary hypertension,a history of ischemic stroke,Hunt-Hess classification grades Ⅳ-Ⅴ,modified Fisher Scale score of 3-4,concomitant cerebral vasospasm and pulmonary infections have an increased risk of short-term mortality,whereas patients with aSAH who have a GCS of 13-15 points and who are treated with endovascular embolization have a relatively low risk of short-term mortality.
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