|
|
自发性蛛网膜下腔出血并发急性脑积水的相关因素分析
|
Abstract:
目的：探讨自发性蛛网膜下腔出血后并发急性脑积水的相关危险因素。方法：选取西安市中心医院神经外科收治的162例蛛网膜下腔出血的患者作为研究对象，统计患者的年龄、性别、饮酒史、吸烟史、高血压病史、糖尿病史、入院时是否昏迷、入院时是否呕吐、GCS评分、脑室出血、早期腰大池引流术、早期锥颅置管引流术、颅内动脉瘤等相关资料，本研究采用二元Logistic回归模型，深入剖析自发性蛛网膜下腔出血(SAH)患者并发急性脑积水(AHC)的相关危险因素。P < 0.05为差异有统计学意义。结果：发生急性脑积水的患者平均年龄大于未患急性脑积水患者平均年龄；女性患急性脑积水的比例大于男性；无饮酒史的患者患急性脑积水的比率大于有饮酒史的患者；不吸烟的患者患急性脑积水的比例大于吸烟患者；有高血压病史的患者患急性脑积水的比例大于无高血压病史的患者；有糖尿病病史的患者患急性脑积水的比例大于无糖尿病病史的患者；入院时昏迷的患者发生急性脑积水的概率高；入院时呕吐的患者发生急性脑积水的概率高；GCS评分 ≥ 8分的患者患急性脑积水的概率更高；早期脑室积血的患者患急性脑积水的概率更高；早期未接受锥颅置管引流术治疗的患者患急性脑积水的比例更高。早期腰大池引流术、糖尿病史无统计学意义，P > 0.05。是否有动脉瘤与急性脑积水的发生无统计学意义，P = 0.663。Hunt-Hess分级更高的患者发生急性脑积水的比例Hunt-Hess分级低的患者；患急性脑积水的患者动脉瘤直径大于未患急性脑积水的患者；动脉瘤位置、是否接受动脉瘤栓塞术无统计学意义，P > 0.05。多因素Logistic回归分析显示，年龄、GCS < 8分、脑室积血、入院时呕吐、入院时昏迷是自发性蛛网膜下腔出血患者并发急性脑积水的危险因素。讨论：自发性蛛网膜下腔出血患者并发急性脑积水的相关因素为年龄、GCS < 8分、脑室积血、入院时呕吐、入院时昏迷，动脉瘤性蛛网膜下腔出血患者并发急性脑积水的相关因素为动脉瘤的大小、Hunt-Hess分级。
Objective: To explore the associated risk factors for the development of acute hydrocephalus following spontaneous subarachnoid hemorrhage. Methods: A total of 162 patients with spontaneous subarachnoid hemorrhage admitted to the Department of Neurosurgery at Xi’an Central Hospital were selected as the subjects of this study. Data including patient age, gender, drinking history, smoking history, history of hypertension, history of diabetes, coma on admission, vomiting on admission, GCS score, intracerebral hemorrhage, early ventricular hemorrhage, early lumbar puncture, early placement of external ventricular drainage, intracranial aneurysm, and other relevant information were collected. Multifactor Logistic regression analysis was used to assess the associated risk factors for the development of acute hydrocephalus in patients with spontaneous subarachnoid hemorrhage. A P-value of less than 0.05 was considered to indicate statistical significance. Results: Patients who developed acute hydrocephalus had a higher average age than those who did not; the proportion of females with acute hydrocephalus was greater than that of males; the rate of acute hydrocephalus in patients without a history of alcohol consumption was higher than those with a history of alcohol consumption; the proportion of patients who did not smoke and developed acute hydrocephalus was greater than those who smoked; patients with a history of hypertension had a higher proportion of acute hydrocephalus than those without a history of hypertension; the proportion
| [1] | Claassen, J. and Park, S. (2022) Spontaneous Subarachnoid Haemorrhage. The Lancet, 400, 846-862. https://doi.org/10.1016/s0140-6736(22)00938-2 |
| [2] | van Gijn, J., Kerr, R.S. and Rinkel, G.J. (2007) Subarachnoid Haemorrhage. The Lancet, 369, 306-318. https://doi.org/10.1016/s0140-6736(07)60153-6 |
| [3] | Hop, J.W., Rinkel, G.J.E., Algra, A. and van Gijn, J. (1997) Case-Fatality Rates and Functional Outcome after Subarachnoid Hemorrhage: A Systematic Review. Stroke, 28, 660-664. https://doi.org/10.1161/01.str.28.3.660 |
| [4] | Feigin, V.L., Lawes, C.M., Bennett, D.A., Barker-Collo, S.L. and Parag, V. (2009) Worldwide Stroke Incidence and Early Case Fatality Reported in 56 Population-Based Studies: A Systematic Review. The Lancet Neurology, 8, 355-369. https://doi.org/10.1016/s1474-4422(09)70025-0 |
| [5] | Korja, M., Lehto, H., Juvela, S. and Kaprio, J. (2016) Incidence of Subarachnoid Hemorrhage Is Decreasing Together with Decreasing Smoking Rates. Neurology, 87, 1118-1123. https://doi.org/10.1212/wnl.0000000000003091 |
| [6] | Korja, M., Silventoinen, K., Laatikainen, T., Jousilahti, P., Salomaa, V. and Kaprio, J. (2013) Cause-Specific Mortality of 1-Year Survivors of Subarachnoid Hemorrhage. Neurology, 80, 481-486. https://doi.org/10.1212/wnl.0b013e31827f0fb5 |
| [7] | Raimondi, A.J. and Torres, H. (1973) Acute Hydrocephalus as a Complication of Subarachnoid Hemorrhage. Surgical Neurology, 1, 23-26. |
| [8] | Kusske, J.A., Turner, P.T., Ojemann, G.A. and Harris, A.B. (1973) Ventriculostomy for the Treatment of Acute Hydrocephalus Following Subarachnoid Hemorrhage. Journal of Neurosurgery, 38, 591-595. https://doi.org/10.3171/jns.1973.38.5.0591 |
| [9] | Vale, F.L., Bradley, E.L. and Fisher, W.S. (1997) The Relationship of Subarachnoid Hemorrhage and the Need for Postoperative Shunting. Journal of Neurosurgery, 86, 462-466. https://doi.org/10.3171/jns.1997.86.3.0462 |
| [10] | Rajshekhar, V. and Harbaugh, R.E. (1992) Results of Routine Ventriculostomy with External Ventricular Drainage for Acute Hydrocephalus Following Subarachnoid Haemorrhage. Acta Neurochirurgica, 115, 8-14. https://doi.org/10.1007/bf01400584 |
| [11] | Zaidi, H.A., Montoure, A., Elhadi, A., Nakaji, P., McDougall, C.G., Albuquerque, F.C., et al. (2015) Long-Term Functional Outcomes and Predictors of Shunt-Dependent Hydrocephalus after Treatment of Ruptured Intracranial Aneurysms in the BRAT Trial. Neurosurgery, 76, 608-615. https://doi.org/10.1227/neu.0000000000000677 |
| [12] | Suarez-Rivera, O. (1998) Acute Hydrocephalus after Subarachnoid Hemorrhage. Surgical Neurology, 49, 563-565. https://doi.org/10.1016/s0090-3019(97)00342-x |
| [13] | de Oliveira, J.G., Beck, J., Setzer, M., Gerlach, R., Vatter, H., Seifert, V., et al. (2007) Risk of Shunt-Dependent Hydrocephalus after Occlusion of Ruptured Intracranial Aneurysms by Surgical Clipping or Endovascular Coiling. Neurosurgery, 61, 924-934. https://doi.org/10.1227/01.neu.0000303188.72425.24 |
| [14] | Paisan, G.M., Ding, D., Starke, R.M., Crowley, R.W. and Liu, K.C. (2017) Shunt-Dependent Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage: Predictors and Long-Term Functional Outcomes. Neurosurgery, 83, 393-402. https://doi.org/10.1093/neuros/nyx393 |
| [15] | Hoh, B.L., Ko, N.U., Amin-Hanjani, S., Chou, S.H., Cruz-Flores, S., Dangayach, N.S., et al. (2023) 2023 Guideline for the Management of Patients with Aneurysmal Subarachnoid Hemorrhage: A Guideline from the American Heart Association/American Stroke Association. Stroke, 54, e314-e370. https://doi.org/10.1161/str.0000000000000436 |
| [16] | Hua, C. and Zhao, G. (2017) Biomarkers in Adult Posthemorrhagic Hydrocephalus. International Journal of Stroke, 12, 574-579. https://doi.org/10.1177/1747493017706187 |
| [17] | Fang, Y., Liu, Y., Chen, L., Wang, J., Zhang, J., Zhang, H., et al. (2024) Cerebrospinal Fluid Markers of Neuroinflammation and Coagulation in Severe Cerebral Edema and Chronic Hydrocephalus after Subarachnoid Hemorrhage: A Prospective Study. Journal of Neuroinflammation, 21, Article No. 237. https://doi.org/10.1186/s12974-024-03236-y |
| [18] | Dandy, W.E. (1919) Experimental Hydrocephalus. Annals of Surgery, 70, 129-142. https://doi.org/10.1097/00000658-191908000-00001 |
| [19] | Andeweg, J. (1991) Concepts of Cerebral Venous Drainage and the Aetiology of Hydrocephalus. Journal of Neurology, Neurosurgery & Psychiatry, 54, 830-831. https://doi.org/10.1136/jnnp.54.9.830 |
| [20] | Orešković, D., Klarica, M. and Vukić, M. (2002) The Formation and Circulation of Cerebrospinal Fluid Inside the Cat Brain Ventricles: A Fact or an Illusion? Neuroscience Letters, 327, 103-106. https://doi.org/10.1016/s0304-3940(02)00395-6 |
| [21] | Bulat, M. and Klarica, M. (2011) Recent Insights into a New Hydrodynamics of the Cerebrospinal Fluid. Brain Research Reviews, 65, 99-112. https://doi.org/10.1016/j.brainresrev.2010.08.002 |
| [22] | Sakka, L., Coll, G. and Chazal, J. (2011) Anatomy and Physiology of Cerebrospinal Fluid. European Annals of Otorhinolaryngology, Head and Neck Diseases, 128, 309-316. https://doi.org/10.1016/j.anorl.2011.03.002 |
| [23] | Thompson, D., Brissette, C.A. and Watt, J.A. (2022) The Choroid Plexus and Its Role in the Pathogenesis of Neurological Infections. Fluids and Barriers of the CNS, 19, Article No. 75. https://doi.org/10.1186/s12987-022-00372-6 |
| [24] | Chen, Y., Luo, Z., Sun, Y., Li, F., Han, Z., Qi, B., et al. (2022) Exercise Improves Choroid Plexus Epithelial Cells Metabolism to Prevent Glial Cell-Associated Neurodegeneration. Frontiers in Pharmacology, 13, Article 1010785. https://doi.org/10.3389/fphar.2022.1010785 |
| [25] | Faure, G.C. (2003) Choroid Plexus Ageing of the Brain and Alzheimer S Disease. Frontiers in Bioscience, 8, s515-s521. https://doi.org/10.2741/1085 |
| [26] | Redzic, Z.B., Preston, J.E., Duncan, J.A., Chodobski, A. and Szmydynger‐Chodobska, J. (2005) The Choroid Plexus‐cerebrospinal Fluid System: From Development to Aging. Current Topics in Developmental Biology, 71, 1-52. https://doi.org/10.1016/s0070-2153(05)71001-2 |
| [27] | Preston, J.E. (2001) Ageing Choroid Plexus‐cerebrospinal Fluid System. Microscopy Research and Technique, 52, 31-37. https://doi.org/10.1002/1097-0029(20010101)52:1<31::aid-jemt5>3.3.co;2-k |
| [28] | Jartti, P., Karttunen, A., Jartti, A., Ukkola, V., Sajanti, J. and Pyhtinen, J. (2004) Factors Related to Acute Hydrocephalus after Subarachnoid Hemorrhage. Acta Radiologica, 45, 333-339. https://doi.org/10.1080/02841850410004274 |
| [29] | Strahle, J., Garton, H.J.L., Maher, C.O., Muraszko, K.M., Keep, R.F. and Xi, G. (2012) Mechanisms of Hydrocephalus after Neonatal and Adult Intraventricular Hemorrhage. Translational Stroke Research, 3, 25-38. https://doi.org/10.1007/s12975-012-0182-9 |
| [30] | Klarica, M., Orešković, D., Božić, B., Vukić, M., Butković, V. and Bulat, M. (2009) New Experimental Model of Acute Aqueductal Blockage in Cats: Effects on Cerebrospinal Fluid Pressure and the Size of Brain Ventricles. Neuroscience, 158, 1397-1405. https://doi.org/10.1016/j.neuroscience.2008.11.041 |
| [31] | Karimy, J.K., Zhang, J., Kurland, D.B., Theriault, B.C., Duran, D., Stokum, J.A., et al. (2017) Inflammation-Dependent Cerebrospinal Fluid Hypersecretion by the Choroid Plexus Epithelium in Posthemorrhagic Hydrocephalus. Nature Medicine, 23, 997-1003. https://doi.org/10.1038/nm.4361 |
| [32] | Miller, B.A., Turan, N., Chau, M. and Pradilla, G. (2014) Inflammation, Vasospasm, and Brain Injury after Subarachnoid Hemorrhage. BioMed Research International, 2014, 1-16. https://doi.org/10.1155/2014/384342 |
| [33] | Lauzier, D.C., Jayaraman, K., Yuan, J.Y., Diwan, D., Vellimana, A.K., Osbun, J.W., et al. (2023) Early Brain Injury after Subarachnoid Hemorrhage: Incidence and Mechanisms. Stroke, 54, 1426-1440. https://doi.org/10.1161/strokeaha.122.040072 |
| [34] | Ostrowski, R.P., Colohan, A.R. and Zhang, J.H. (2006) Molecular Mechanisms of Early Brain Injury after Subarachnoid Hemorrhage. Neurological Research, 28, 399-414. https://doi.org/10.1179/016164106x115008 |
| [35] | Sehba, F.A., Schwartz, A.Y., Chereshnev, I. and Bederson, J.B. (2000) Acute Decrease in Cerebral Nitric Oxide Levels after Subarachnoid Hemorrhage. Journal of Cerebral Blood Flow & Metabolism, 20, 604-611. https://doi.org/10.1097/00004647-200003000-00018 |
| [36] | Li, Y., Wu, P., Bihl, J.C. and Shi, H. (2020) Underlying Mechanisms and Potential Therapeutic Molecular Targets in Blood-Brain Barrier Disruption after Subarachnoid Hemorrhage. Current Neuropharmacology, 18, 1168-1179. https://doi.org/10.2174/1570159x18666200106154203 |
| [37] | Hayman, E.G., Wessell, A., Gerzanich, V., Sheth, K.N. and Simard, J.M. (2016) Mechanisms of Global Cerebral Edema Formation in Aneurysmal Subarachnoid Hemorrhage. Neurocritical Care, 26, 301-310. https://doi.org/10.1007/s12028-016-0354-7 |
| [38] | Macdonald, R.L. and Schweizer, T.A. (2017) Spontaneous Subarachnoid Haemorrhage. The Lancet, 389, 655-666. https://doi.org/10.1016/s0140-6736(16)30668-7 |
| [39] | Shishido, H., Zhang, H., Okubo, S., Hua, Y., Keep, R.F. and Xi, G. (2016) The Effect of Gender on Acute Hydrocephalus after Experimental Subarachnoid Hemorrhage. In: Applegate, R., Chen, G., Feng, H. and Zhang, J., Eds., Brain Edema XVI, Springer, 335-339. https://doi.org/10.1007/978-3-319-18497-5_58 |
| [40] | Demirgil, B.T., Tugcu, B., Postalci, L., Guclu, G., Dalgic, A. and Oral, Z. (2003) Factors Leading to Hydrocephalus after Aneurysmal Sub-Arachnoid Hemorrhage. Minimally Invasive Neurosurgery, 46, 344-348. |
| [41] | Rincon, F., Gordon, E., Starke, R.M., Buitrago, M.M., Fernandez, A., Schmidt, J.M., et al. (2010) Predictors of Long-Term Shunt-Dependent Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage. Journal of Neurosurgery, 113, 774-780. https://doi.org/10.3171/2010.2.jns09376 |
