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

文唐敏; 苏俊; 谭嘉禾; 辛元君; 车旭东; 梁译丹; 邓杰文; 杨小林; 何朝晖

doi:10.16016/j.2097-0927.202306089

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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

临床医学 | 更新时间：2026-01-09

- 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
- Continuous lumbar drainage improves prognosis in patients with acute hydrocephalus after aneurysmal subarachnoid hemorrhage
- 陆军军医大学学报 2024年46卷第4期页码：384-390
- 作者机构：
  
  1.400016 重庆，重庆医科大学附属第一医院神经外科
  2.401220 重庆，重庆市长寿区人民医院神经外科
  3.408499 重庆，重庆市南川区人民医院神经外科
  4.400014 重庆，重庆市急救中心神经外科
- 作者简介：
  
  [何朝晖，E-mail: geno_he@163.comHE Zhaohui, E-mail: geno_he@163.com
- 基金信息：
  
  重庆市自然科学基金面上项目(CSTB2023NSCQ-MSX0112)
- DOI：10.16016/j.2097-0927.202306089
  中图分类号： R651.12;R742.7;R743.35
- 收稿：2023-06-24，
  
  修回：2023-09-01，
  
  纸质出版：2024-02-28
- 稿件说明：
移动端阅览
文唐敏, 苏俊, 谭嘉禾, 等. 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[J]. 陆军军医大学学报, 2024,46(4):384-390.

Tangmin WEN, Jun SU, Jiahe TAN, et al. Continuous lumbar drainage improves prognosis in patients with acute hydrocephalus after aneurysmal subarachnoid hemorrhage[J]. Journal of Army Medical University, 2024, 46(4): 384-390.
文唐敏, 苏俊, 谭嘉禾, 等. 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[J]. 陆军军医大学学报, 2024,46(4):384-390. DOI： 10.16016/j.2097-0927.202306089.

Tangmin WEN, Jun SU, Jiahe TAN, et al. Continuous lumbar drainage improves prognosis in patients with acute hydrocephalus after aneurysmal subarachnoid hemorrhage[J]. Journal of Army Medical University, 2024, 46(4): 384-390. DOI： 10.16016/j.2097-0927.202306089.

摘要

目的

分析腰池引流量对动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage

aSAH)后急性脑积水(acute hydrocephalus

AHC)预后的影响。

方法

纳入2017年1月至2022年1月就诊于重庆医科大学附属第一医院神经外科因动脉瘤性蛛网膜下腔出血发生AHC的患者82例。以出院半年后改良Rankin评分量表(modified Rankin scale

mRS)评分为预后结局

对人口学因素、入院时蛛网膜下腔出血(subarachnoid hemorrhage

SAH)严重程度、既往史、血管痉挛、腰池引流等数据进行单因素和多因素Logistic逐步回归分析

并构建列线图预测模型。

结果

单因素分析发现WFNS、Hunt-Hess、mFisher、腰池引流时间、分流依赖、脑血管痉挛、腰池引流量可影响患者预后

进一步采用Logistic逐步回归分析

发现高评分WFNS (

: 3.25

95%

: 1.11~9.48)、mFisher高分级(

: 3.66

95%

: 1.08~12.35)、发生分流依赖(

: 15.56

95%

: 1.22~198.57)与脑血管痉挛(

: 22.24

95%

: 3.08~160.68)是影响mRS的独立危险因素

腰池引流量(

: 0.57

95%

: 0.40~0.82)是独立保护因素。ROC曲线面积显示模型具有良好的预测效果[AUC: 0.898(95%

: 0.935~0.861)

]

; 通过Bootstrap方法进行内部验证

结果显示模型具很好的区分能力[C-index: 0.950(95%

: 0.904~0.996);校正C-index: 0.934

]

。

结论

增加腰池引流量是aSAH术后发生AHC预后不良的独立保护因素

并可以改善SAH患者的预后。

Abstract

Objective

To analyze the influence of drainage volume on prognosis of acute hydrocephalus (AHC) after aneurysmal subarachnoid hemorrhage (aSAH) by continuous lumbar drainage.

Methods

A retrospective trial was conducted on 82 AHC patients after aSAH admitted to the First Affiliated Hospital of Chongqing Medical University between January 2017 and January 2022.In 6 months after discharge

modified Rankin Scale (mRS) score was used to evaluate the prognostic outcomes.Univariate and multivariate logistic regression analyses were performed on demographic factors

severity of subarachnoid hemorrhage (SAH) at admission

medical history

cerebral vasospasm

and lumbar drainage data.Then a nomogram prediction model was constructed.

Results

Univariate analysis found that World Federation of Neurosurgical Societies (WFNS) score

Hunt-Hess grade

modified Fisher grade

time for continuous lumbar drainage

shunt dependence

cerebral vasospasm

and drainage volume were factors affecting the prognosis of the patients.Then logistic regression analysis revealed that high WFNS score (

: 3.25

95%

: 1.11~9.48)

high modified Fisher grade (

: 3.66

95%

: 1.08~12.35)

shunt dependence (

: 15.56

95%

: 1.22~198.57)

and cerebral vasospasm (

: 22.24

95%

: 3.08~160.68) were independent predictors for mRS score

while volume of continuous lumbar draina

ge (

: 0.57

95%

: 0.40~0.82) was an independent protective factor.ROC curve analysis indicated a good predictive performance of the model (AUC=0.898

95%

: 0.935~0.861).Internal validation through Bootstrap method demonstrated excellent discriminatory ability of the model (C-index=0.950

95%

: 0.904~0.996;adjusted C-index: 0.934).

Conclusion

Increased volume of lumbar drainage is an independent protective factor for poor prognosis following aSAH and can improve the prognosis of SAH patients.

关键词

Keywords

references

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