【摘要】 目的 探讨高Hunt-Hess分级动脉瘤性蛛网膜下腔出血（aSAH）患者出现慢性意识障碍（pDoC）的影响因素。方法 采集2018年5月至2022年4月在邯郸市中心医院治疗的88例高Hunt-Hess分级aSAH患者的术前临床资料。治疗后28 d开始参照昏迷恢复量表-修订版（CRS-R）评估意识状态，每半个月评估1次，共评估6次，根据最高分数的量表评估结果将患者意识状态分为pDoC组和非pDoC组。多因素Logistic回归分析高Hunt-Hess分级a SAH患者治疗后发生pDoC的影响因素。利用ROC曲线分析预测pDoC的效能。结果 pDoC组与非pDoC组患者术前是否出现颅内血肿、破入脑室、急性脑积水、血糖水平、血糖/血钾比值、白细胞计数比较，差异具有统计学意义（P <0.05）。多因素Logistic回归分析显示颅内血肿、急性脑积水、血糖水平、白细胞计数与高分级aSAH治疗后是否发生pDoC有关（OR=2.373、5.984、1.420、1.179,P <0.05）。ROC曲线分析结果提示，血糖、白细胞计数、颅内血肿和急性脑积水预测发生pDoC的AUC分别为0.755(95%CI=0.647～0.864)、0.706(95%CI=0.590～0.821)、0.763(95%CI=0.658～0.869)、0.708(95%CI=0.593～0.822)。血糖、白细胞计数约登指数为0.446、0.353；敏感度为82.14%、71.43%；特异度为65.63%、62.50%。血糖、白细胞计数最佳截断值分别为13.25 mmol/L、19.65×10~9/L。结论 发生颅内血肿和急性脑积水以及术前血糖和白细胞计数是高Hunt-Hess分级aSAH患者pDoC发生的影响因素，这些指标对高Hunt-Hess分级aSAH患者治疗后发生pDoC具有较高的预测价值。更多还原

【Abstract】 Objective To investigate the influencing factors contributing to the occurrence of prolonged disorders of consciousness(pDoC) in patients with high Hunt-Hess grade aneurysmal subarachnoid hemorrhage(aSAH). Methods Preoperative clinical data of 88 patients with high Hunt-Hess grade aSAH treated at Handan Central Hospital from May 2018 to April 2022 were collected.Consciousness status was evaluated using the Coma Recovery Scale Revised Version(CRS-R) starting at 28 days after treatment, with assessments conducted every half month for a total of 6 times. Patients were divided into pDoC group and non-pDoC group based on the highest score obtained from the scale.Influencing factors for the occurrence of pDoC after treatment in patients with high Hunt-Hess grade aSAH were analyzed by multivariate Logistic regression. The efficacy of predicting pDoC was analyzed using ROC curve. Results Significant differences were observed between the pDoC group and the non-pDoC group in terms of preoperative intracranial hematoma, intraventricular rupture, acute hydrocephalus, blood glucose, blood glucose/potassium ratio, and white blood cell count(P < 0.05).Multivariate Logistic regression analysis showed that intracranial hematoma, acute hydrocephalus,blood glucose, and white blood cell count were associated with the occurrence of pDoC after treatment for high-grade aSAH(OR=2.373, 5.984, 1.420, 1.179; P < 0.05). ROC curve analysis suggested that AUCs of blood glucose, white blood cell count, intracranial hematoma, and acute hydrocephalus for predicting the occurrence of p Do C were 0.755(95%CI=0.647-0.864), 0.706(95%CI=0.590-0.821), 0.763(95%CI=0.658-0.869), and 0.708(95%CI=0.593-0.822), respectively. The Yoden index for blood glucose and white blood cell count were 0.446 and 0.353, respectively, with sensitivity of 82.14% and 71.43%, and specificity of 65.63% and 62.50%. The optimal cut-off values for blood glucose and white blood cell count were 13.25 mmol/L and 19.65×10~9/L, respectively. Conclusion Intracranial hematoma, acute hydrocephalus, preoperative blood glucose and white blood cell count are influencing factors for the occurence of p Do C in patients with high Hunt-Hess grade a SAH, providing significant predictive value for p Do C after treatment in these patients.更多还原