动脉瘤性蛛网膜下腔出血术后慢性脑积水危险因素分析

文唐敏; 陈才华

doi:10.16016/j.1000-5404.202105114

您当前的位置：

首页 >

文章列表页 >

动脉瘤性蛛网膜下腔出血术后慢性脑积水危险因素分析

临床医学 | 更新时间：2026-01-09

- 动脉瘤性蛛网膜下腔出血术后慢性脑积水危险因素分析
- Risk factors of chronic hydrocephalus after operation of aneurysmal subarachnoid hemorrhage
- 第三军医大学学报 2021年43卷第22期页码：2474-2479
- 作者机构：
  
  401220 重庆，重庆市长寿区人民医院神经外科
- 作者简介：
  
  [陈才华，E-mail: 409121786@qq.com CHEN Caihua, E-mail: 409121786@qq.com
- 基金信息：
- DOI：10.16016/j.1000-5404.202105114
  中图分类号： R181.32;R742.7;R743.35
- 收稿：2021-05-24，
  
  修回：2021-06-01，
  
  纸质出版：2021-11-30
- 稿件说明：
移动端阅览
文唐敏, 陈才华. 动脉瘤性蛛网膜下腔出血术后慢性脑积水危险因素分析[J]. 第三军医大学学报, 2021,43(22):2474-2479.

Tangmin WEN, Caihua CHEN. Risk factors of chronic hydrocephalus after operation of aneurysmal subarachnoid hemorrhage[J]. Journal of Third Military Medical University, 2021, 43(22): 2474-2479.
文唐敏, 陈才华. 动脉瘤性蛛网膜下腔出血术后慢性脑积水危险因素分析[J]. 第三军医大学学报, 2021,43(22):2474-2479. DOI： 10.16016/j.1000-5404.202105114.

Tangmin WEN, Caihua CHEN. Risk factors of chronic hydrocephalus after operation of aneurysmal subarachnoid hemorrhage[J]. Journal of Third Military Medical University, 2021, 43(22): 2474-2479. DOI： 10.16016/j.1000-5404.202105114.

摘要

目的

分析动脉瘤性蛛网膜下腔出血术后发生慢性脑积水的独立危险因素。

方法

回顾性分析2014年12月至2020年12月我院神经外科收治的99例动脉瘤性蛛网膜下腔出血患者，查阅病历资料记录患者年龄、性别、烟酒史、高血压病史、出血是否破入脑室、是否合并脑内血肿、动脉瘤位置、发生出血的次数、入院Fisher分级、Hunt-Hess分级、是否行腰大池引流术、是否行脑室外引流、是否颅内感染。99例手术治疗的动脉瘤性蛛网膜下腔出血患者中，发生慢性脑积水30例，未发生脑积水69例，采用单因素和多因素Logistic回归分析筛选发生脑积水的危险因素。

结果

单因素方差分析结果显示：年龄、Fisher分级、Hunt-Hess分级高和多次出血明显增加术后慢性脑积水的发生率（

0.05）。χ

检验结果显示：出血破入脑室、脑内血肿、腰大池引流、脑室外引流以及颅内感染等明显增加慢性脑积水的发生率（

0.05）。二元Logistic回归分析结果显示：动脉瘤性蛛网膜下腔出血术后发生慢性脑积水的独立危险因素有蛛网膜下腔出血破入脑室（

=0.003）、合并脑内血肿（

=0.005）、Hunt-Hess分级较高（

=0.006）、Fisher分级较高（

=0.011）、行脑室外引流（

=0.005）、行腰大池引流（

=0.008）、颅内感染（

=0.039）。

结论

出血破入脑室、合并脑内血肿、高等级的Hunt-Hess与Fisher分级、脑室外引流、腰大池引流、颅内感染等均是动脉瘤蛛网膜下腔出血患者术后发生慢性脑积水的独立危险因素。

Abstract

Objective

To identify the independent risk factors of chronic hydrocephalus in patients after the operation of aneurysmal subarachnoid hemorrhage (aSAH).

Methods

The clinical data of 99 patients with aSAH treated in our hospital from December 2014 to December 2020 were collected and retrospectively analyzed

including age

gender

history of smoking and drinking

hypertension

intraventricular hemorrhage or not

complicated with intracerebral hematoma or not

lumbar cistern drainage

ventricular drainage

intracranial infection or not

location of aneurysm

frequency of hemorrhage

and results of Fisher Grading Scale and Hunt-Hess Classification of SAH. Among the 99 cases of aSAH

30 patients developed postoperative chronic hydrocephalus. Univariate and multivariate logistic regression analysis were performed to screen the risk factors of chronic hydrocephalus.

Results

The results of one-way ANOVA indicated that older age

higher Fisher grade and Hunt-Hess grade

and more bleeding times significantly increased the incidence of postoperative chronic hydrocephalus (

0.05); meanwhile

Chi-square

test showed that intraventricular hemorrhage

intracerebral hematoma

lumbar cistern drainage

ventricular drainage

intracranial infection also resulted in elevated incidence of postoperative chronic hydrocephalus (

0.05). Multiple logistic regression analysis presented that intraventricular hemorrhage (

=0.003)

intracerebral hematoma (

=0.005)

higher Hunt-Hess grade (

=0.006)

higher Fisher grade (

=0.011)

ventricular drainage (

=0.005)

lumbar cistern drainage (

=0.008) and intracranial infection (

=0.039) were independent risk factors of chronic hydrocephalus after aSAH operation.

Conclusion

Intraventricular hemorrhage

intracerebral hematoma

higher Hunt-Hess grade and Fisher grade

lumbar cistern drainage

ventricular drainage

and intracranial infection are independent risk factors of postoperative chronic hydrocephalus in patients with aSAH.

关键词

Keywords

references

MACDONALD R L, SCHWEIZER T A. Spontaneous subarachnoid haemorrhage[J]. Lancet, 2017, 389(10069): 655-666. DOI: 10.1016/S0140-6736(16)30668-7.

NIEUWKAMP D J, SETZ L E, ALGRA A, et al . Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis[J ] . Lancet Neurol, 2009, 8(7): 635-642. DOI: 10.1016/S1474-4422(09)70126-7.

NEIFERT S N, CHAPMAN E K, MARTINI M L, et al . Aneurysmal subarachnoid hemorrhage: the last decade[J ] . Transl Stroke Res, 2021, 12(3): 428-446. DOI: 10.1007/s12975-020-00867- 0.

刘贤生, 吴楚伟, 邹隽风, 等. 动脉瘤性蛛网膜下腔出血术后并发分流依赖性脑积水的危险因素分析[J]. 中国微侵袭神经外科杂志, 2020, 25(11): 481-484.

LIU X S, WU C W, ZOU J F, et al . Analysis on risk factors for shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage[J ] . Chin J Minim Invasive Neurosurg, 2020, 25(11): 481-484.

CHEN S, LUO J Q, REIS C, et al . Hydrocephalus after subarachnoid hemorrhage: pathophysiology, diagnosis, and treatment[J ] . Biomed Res Int, 2017, 2017: 8584753. DOI: 10.1155/2017/8584753.

XIE Z, HU X, ZAN X, et al . Predictors of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage? A systematic review and meta-analysis[J ] . World Neurosurg, 2017, 106: 844-860. e6. DOI: 10.1016/j.wneu.2017.06.119.

XU H, DING W, The risk factors of shunt-dependent hydrocephalus after subarachnoid space hemorrhage of intracranial aneurysms[J]. Medicine (Baltimore), 2019, 98: e15970. DOI: 10.1097/MD.0000000000015970.

吴伟东. 动脉瘤性蛛网膜下腔出血显微外科术后发生慢性脑积水的相关危险因素分析及预防[D]. 大连: 大连医科大学, 2020.

WU W D. The risk factors analysis and prevention of chronic hydrocephalus after aneurysmal subarachnoid hemorrhage by microsurgery[D]. Dalian: Dalian Medical University, 2020.

VALE F L, BRADLEY E L, FISHER W S. The relationship of subarachnoid hemorrhage and the need for postoperative shunting[J]. J Neurosurg, 1997, 86(3): 462-466. DOI: 10.3171/jns.1997.86.3.0462.

KOMOTAR R J, HAHN D K, KIM G H, et al . Efficacy of Lamina terminalis fenestration in reducing shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage: a systematic review[J ] . J Neurosurg, 2009, 111(1): 147-154. DOI: 10.3171/2009.1.jns0821.

WILSON C D, SAFAVI-ABBASI S, SUN H, et al . Meta-analysis and systematic review of risk factors for shunt dependency after aneurysmal subarachnoidhemorrhage[J ] . J Neurosurg, 2017, 126(2): 586-595. DOI: 10.3171/2015.11.jns152094.

袁琦斌. 开颅动脉瘤夹闭术后脑积水危险因素的分析[D]. 新乡: 新乡医学院, 2020.

YUAN Q B. Analysis of the risk factors of hydrocephalus after intracranial aneurysm clipping[D]. Xinxiang: Xinxiang Medical College, 2020.

吕岩松. 动脉瘤性蛛网膜下腔出血后慢性脑积水形成的相关因素分析[J]. 中国现代医生, 2015, 53(17): 29-31.

LYU Y S. Analysis on related factors for chronic hydrocephalus formation after aneurysmal subarachnoid hemorrhage[J]. China Mod Dr, 2015, 53(17): 29-31.

张翔, 程远, 谢宗义. 动脉瘤性蛛网膜下腔出血后慢性分流依赖性脑积水的研究进展[J]. 国际神经病学神经外科学杂志, 2014, 41(1): 54-57. DOI: 10.16636/j.cnki.jinn.2014.01.019.

ZHANG X, CHENG Y, XIE Z Y. Research development of the predictive factor and treatment and pathogenesis of chronic shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage[J]. J Int Neurol Neurosurg, 2014, 41(1): 54-57. DOI: 10.16636/j.cnki.jinn.2014.01.019.

MOTIEI-LANGROUDI R, ADEEB N, FOREMAN P M, et al . Predictors of shunt insertion in aneurysmal subarachnoid hemorrhage[J ] . World Neurosurg, 2017, 98: 421-426. DOI: 10.1016/j.wneu.2016.11.092.

GARTON T, KEEP R F, WILKINSON D A, et al . Intraventricular hemorrhage: the role of blood components in secondary injury and hydrocephalus[J ] . Transl Stroke Res, 2016, 7(6): 447-451. DOI: 10.1007/s12975-016-0480-8.

RINCON F, GORDON E, STARKE R M, et al . Predictors of long-term shunt-dependent hydrocephalus after aneurysmal subarachnoi d hemorrhage. Clinical article[J ] . J Neurosurg, 2010, 113(4): 774-780. DOI: 10.3171/2010.2.JNS09376.

KARIMY J K, ZHANG J W, KURLAND D B, et al . Inflammation-dependent cerebrospinal fluid hypersecretion by the choroid plexus epithelium in posthemorrhagic hydrocephalus. [J ] . Nat Med, 2017, 23: 997-1003. DOI: 10.1038/nm.4361.

LU J J, JI N, YANG Z H, et al . Prognosis and treatment of acute hydrocephalus following aneurysmal subarachnoid haemorrhage[J ] . J Clin Neurosci, 2012, 19(5): 669-672. DOI: 10.1016/j.jocn.2011.06.032.

蔡秀侠, 李加林, 梁珂. 动脉瘤性蛛网膜下腔出血脑脊液红细胞水平与脑积水的关系[J]. 海南医学, 2020, 31(20): 2632-2634.

CAI X X, LI J L, LIANG K. Relationship between the erythrocytes in cerebrospinal fluid and hydrocephalus in aneurysmal subarachnoid hemorrhage[J]. Hainan Med J, 2020, 31(20): 2632-2634.

AKINDURO O O, VIVAS-BUITRAGO T G, HARANHALLI N, et al . Predictors of ventriculoperitoneal shunting following subarachnoid hemorrhage treated with external ventricular drainage[J ] . Neurocrit Care, 2020, 32(3): 755-764. DOI: 10.1007/s12028-019-00802-8.

WEIGL C, BRUENDL E, SCHOEDEL P, et al . Ⅲ. Ventricle diameter increase during ventricular drainage challenge-A predictor of shunt dependency after subarachnoid hemorrhage[J ] . J Clin Neurosci, 2020, 72: 198-201. DOI: 10.1016/j.jocn.2019.12.011.

LEWIS A, IRVINE H, OGILVY C, et al . Predictors for delayed ventriculoperitoneal shunt placement after external ventricular drain removal in patients with subarachnoid hemorrhage[J ] . Br J Neurosurg, 2015, 29(2): 219-224. DOI: 10.3109/02688697.2014.967753.

JABBARLI R, PIERSCIANEK D, RÖLZ R, et al . Gradual external ventricular drainage weaning reduces the risk of shunt dependency after aneurysmal subarachnoid hemorrhage: a pooled analysis[J ] . Oper Neurosurg (Hagerstown), 2018, 15(5): 498-504. DOI: 10.1093/ons/opy009.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

腰池持续引流改善动脉瘤性蛛网膜下腔出血后急性脑积水患者的预后

动脉瘤性蛛网膜下腔出血后迟发性脑缺血早期识别：一项多因素临床预测模型的建立与验证

急性前循环大血管闭塞性卒中患者血管内治疗后发生卒中相关性肺炎的危险因素分析

核仁磷酸蛋白1突变的分子异质性对急性髓系白血病预后的影响

非肌层浸润性膀胱癌二次电切术后疗效评估及预后影响因素分析