【摘要】 目的探讨合并症对脑动脉瘤破裂引起蛛网膜下腔出血(SAH)患者早期预后的影响。方法纳入2000年至2016年于本院收治的经CT证实的223例SAH患者,其中无合并症组80例,患有高血压、高血糖等老年常见疾病的患者143例,入院治疗前统计患者的合并症情况及格拉斯哥昏迷评分法(Glasgow Coma Score,GCS)和世界神经外科医师联盟(The World Federation of Neurosurgical Societies,WFNS)评分,对SAH患者进行初始治疗干预后,采用格拉斯哥预后评分法(GOS)评价两组SAH患者的早期预后,分析各个合并症对合并症组患者预后的影响。T检验比较年龄等计量资料的差异,卡方检验比较性别等计量资料的差异,秩和检验比较GCS等等级资料的组建差异,logistic回归分析影响患者预后的合并症。结果合并症组与非合并症组比较,患者年龄、性别、GCS分级差别不具有统计学差异(P>0.05),而合并症组的WFNS分级整体高于非合并症组(P<0.05)。入院治疗30天后,非合并症组约有71.1%的患者恢复情况较好,合并症组仅有49.7%的患者预后较好。高血压、高血糖和高血脂患者的预后较非该疾病的患者预后差,差异具有统计学意义(P<0.05),而冠心病患者和癌症患者的预后评分与非该疾病患者的预后评分无统计学差异(P>0.05)。logistic多因素回归分析结果显示高血压和糖尿病SAH的危险因素(OR=1.801和1.533),而高血脂不是SAH的危险因素。结论本研究中高血压和高血糖是脑动脉瘤破裂导致的蛛网膜下腔出血老年患者预后的危险因素。更多还原

【Abstract】 Objective To explore the effect of comorbidity on early prognosis in elderly patients with subarachnoid hemorrhage caused by a ruptured cerebral aneurysm(SAH). Methods 223 patients with SAG diagnosed by CT from 2000 to 2016 were enrolled. According to whether they had comorbidity,patients with common diseases such as hypertension were enrolled into comorbidity group(143) and patients without comorbidities were enrolled into a non-comorbidity group(80). Before the treatment,the Glasgow coma score(GCS) and WFNS were used to evaluate the severity of the disease. After the treatment,the Glasgow prognostic score(GOS) was applied to estimate the prognosis condition of SAH patients in the two groups. T-test was used to test the difference in measurement data such as age. Chi-square test was used to test the difference in countable data such as gender,Rank sum test was adopted to analyze the difference in ranked data such as GCS,and at last logistic regression analysis was used to analyze the risk factor of prognosis. Results Compared patients in comorbidity group and non-comorbidity group,there was no significant difference in age,gender and GCS score(P > 0. 05),and the WFNS score of the patients in comorbidity group was higher than that in the non-comorbidity group(P < 0. 05). After treated for 30 days,there were 71. 1% patients making a good recovery in the non-comorbidity group,and 49. 7% patients making a good recovery in comorbidity group(P < 0. 05). The prognosis condition of a patient with hypertension,hyperglycemia and hyperlipaemia in the comorbidity group were much worse than patients without this comorbidity(P < 0. 05),while these prognosis condition of patients with coronary heart disease and cancer were with no difference compared with patients without these diseases(P >0. 05). The logistic regression results revealed that hypertension and hyperglycemia were the risk factors of SAH(OR = 1. 801 and 1. 533),and hyperlipidemia was not a risk factor for SAH. Conclusion In this study,hypertension and hyperglycemia are the risk factors of prognosis with SAH.更多还原