颅内大动脉及小动脉痉挛与蛛网膜下腔出血迟发性脑梗死的相关性分析

doi:10.3969/j.issn.1005-6483.2021.04.017

摘要/Abstract

摘要： 目的：探讨蛛网膜下腔出血(subarachnoid hemorrhage，SAH)迟发性脑梗死(delayed cerebral infarction，DCI)与颅内大动脉和小动脉痉挛的相关性。方法：我院神经外科2014年1月~2019年10月收治的SAH病人170例。根据住院治疗过程中是否发生DCI分为DCI组和无DCI组。比较两组的一般资料、CT灌注成像(CT perfusion imaging，CTP)参数、CT血管造影(CT angiography，CTA)和经颅多普勒(transcranial doppler，TCD)等项目，应用多因素Logistic回归分析不同区域颅内动脉痉挛与病人SAH后DCI的关系。结果：纳入研究的154例病人，有61例出现DCI，DCI发病率为39.61%。DCI组Fisher分级、脑血容量(cerebral blood volume,CBV)和颅内动脉痉挛总发生率均高于无DCI组(P<0.05)；DCI组行腰椎穿刺脑脊液置换病人少于无DCI组(P<0.05)；DCI组脑血流量(cerebral blood flow,CBF)低于无DCI组(P<0.05)。多因素Logistic回归分析显示，Fisher分级、CBV和大血管痉挛是影响病人SAH后DCI的独立危险因素，CBF是影响病人SAH后DCI的保护性因素。结论：颅内大动脉痉挛是影响病人SAH后DCI的独立危险因素，而小血管痉挛与病人SAH后DCI无明显相关性。

关键词: 蛛网膜下腔出血, 迟发性脑梗死, 颅内动脉痉挛, CT灌注成像

Abstract: Objective：To investigate the correlation between delayed cerebral infarction with intracranial aortic and small arterial spasm in subarachnoid hemorrhage.Methods：170 SAH patients admitted to the Department of Neurological Surgery of our hospital from January 2014 to October 2019 were analyzed.DCI was divided into DCI group and DCIfree group according to whether DCI occurred during hospitalization.General data,CT perfusion imaging(CTP) parameters,CT angiography(CTA) and Transcranial Doppler(TCD) were compared between the two groups,multivariate Logistic regression was used to analyze the relationship between intracranial artery spasm in different regions and DCI after SAH.Results：Of the 154 patients included in the study,61 had DCI,with a DCI incidence of 39.61%.The incidence of cerebral blood volume (CBV), cerebral blood volume (cerebral blood volume，CBV) and intracranial artery spasm in DCI group were higher than those in DCIfree group(P<0.05).Fewer patients underwent lumbar puncture CSF replacement in the DCI group than in the DCIfree group(P<0.05).The cerebral blood flow (CBF) in DCI group was lower than that in DCIfree group(P<0.05).Multivariate Logistic regression analysis showed that,Fisher's grade CBV and macrovasosm were independent risk factors for DCI after SAH,CBF was a protective factor affecting DCI of patients after SAH.Conclusion：Intracranial arterial spasm is an independent risk factor for patients with DCI after SAH,while spasm of small arterial has no significant correlation with DCI after SAH.

Key words: subarachnoid hemorrhage, delayed cerebral infarction, intracranial artery spasm, CT perfusion imaging

王勇, 陶治鹤, 田少斌等. 颅内大动脉及小动脉痉挛与蛛网膜下腔出血迟发性脑梗死的相关性分析[J]. 临床外科杂志, 2021, 29(4): 355-359.

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