【摘要】 目的探讨脑脊液引流速度对蛛网膜下腔出血(SAH)患者血清C反应蛋白(CRP)水平的影响及其与预后的关系。方法采用随机数表法,将2016年4月至2018年8月怀集县人民医院神经外科收治的311例SAH患者分为Ⅰ组(103例)、Ⅱ组(104例)、Ⅲ组(104例),三组患者均行腰大池持续引流(LCFD)术,脑脊液引流速度分别为5 mL/h、10 mL/h、15 mL/h,比较三组患者术前和术后1 d、3 d的血清CRP水平和预后情况,并对影响患者预后的因素做单因素和多因素分析。结果三组患者术后1 d、3 d的血清CRP水平均低于术前,术后3 d高于术后1 d,差异均有统计学意义(P<0.05);Ⅱ组、Ⅲ组患者术后1 d、3 d的血清CRP水平均低于Ⅰ组,Ⅱ组术后1 d、3 d的血清CRP水平低于Ⅲ组,差异均有统计学意义(P<0.05);三组患者术后3 d预后情况不同,Ⅱ、Ⅲ组优于Ⅰ组,Ⅱ组优于Ⅲ组,差异均有统计学意义(P<0.05);单因素分析结果显示,Hunt-Hess分级、引流速度及血清CRP水平是影响SAH患者预后的危险因素(P<0.05);多因素Logistic回归分析显示,Hunt-Hess分级、术后1 d和术后3 d血清CRP水平是影响SAH患者预后的独立危险因素(P<0.05);术后3 d血清CRP水平预测SAH患者预后不良的曲线下面积(AUC)为0.761,大于术后1 d的0.641,预测价值更好。结论脑脊液引流速度10 mL/h对SAH患者术后血清CRP水平负性影响较小,更有助于改善患者预后,血清CRP水平可作为患者预后不良的预测指标。更多还原

【Abstract】 Objective To explore the effect of cerebrospinal fluid drainage rate on serum C-reactive protein(CRP) levels in patients with subarachnoid hemorrhage(SAH) and its relationship with prognosis. Methods A total of311 patients with SAH treated in the Department of Neurosurgery at the Huaiji County People’s Hospital from April2016 to August 2018 were divided into group Ⅰ(103 cases), group Ⅱ(104 cases) and group Ⅲ(104 cases) according to the random number table method. Three groups of patients were given continuous lumbar cerebrospinal fluid drainage(LCFD), and the cerebrospinal fluid drainage rates were 5 mL/h, 10 mL/h and 15 mL/h, respectively. The serum CRP levels and prognosis of the three groups were compared before operation and at 1 day and 3 days after operation, and the factors affecting the prognosis of patients were analyzed by univariate and multivariate analysis. Results The levels of serum CRP in the three groups at 1 day and 3 days after operation were lower than those before operation, and the level at 3 d after operation was higher than that at 1 d after operation(P<0.05). The serum CRP levels in group Ⅱ and groupⅢ at 1 d and 3 d after operation were lower than those in group Ⅰ, and the serum CRP levels in group Ⅱ at 1 d and 3 d after operation were lower than those in group Ⅲ(P<0.05). The prognosis of the three groups was different at 3 days after operation. The prognosis in group Ⅱ and group Ⅲ was better than that in group Ⅰ, and the prognosis in group Ⅱwas better than that in group Ⅲ(P<0.05). Univariate analysis results showed that Hunt-Hess classification, drainage rate and serum CRP levels were risk factors affecting the prognosis of SAH patients(P<0.05). Multivariate logistic regression analysis showed that Hunt-Hess classification and serum CRP level at 1 d and 3 d after operation were independent risk factors for the prognosis of patients with SAH(P<0.05). The area under the curve(AUC) of serum CRP levels at 3 d after operation was 0.761 in predicting the poor prognosis of patients with SAH, which was greater than 0.641 at 1 d after operation, and the predicted value was better. Conclusion Cerebrospinal fluid drainage rate of 10 mL/h has little negative effects on serum CRP levels in patients with SAH, which is more helpful to improve the prognosis of patients.Serum CRP level can be used as a predictor for poor prognosis.更多还原