Fisher Ⅲ-Ⅳ级颅内动脉瘤并发脑积水的影响因素分析

目的探讨Fisher Ⅲ-Ⅳ级颅内动脉瘤性蛛网膜下腔出血患者并脑积水的相关危险因素。方法纳入宁夏医科大学总医院神经外科2015年5月—2022年1月收治的313例破裂颅内动脉瘤性蛛网膜下腔出血Fisher Ⅲ-Ⅳ患者，根据不同治疗方式，分别比较并发脑积水和非脑积水2组患者的临床数据资料，经多因素Logistic回归分析患者发生脑积水的独立危险因素。通过独立危险因素构建预测模型，结合受试者工作特征(ROC)曲线，分析模型对患者并发脑积水的预测价值。结果经单因素分析出开颅夹闭和血管内患者术后合并脑积水分别与Fisher Ⅳ级（P=0.004）、持续腰大池引流（LD）（P=0.017）和Hunt-Hess Ⅲ-V 级（P=0.003）、Fisher Ⅳ级（P=0.005）、去骨瓣减压术（P=0.042）、肺炎（P=0.016）相关。经多因素分析得出，开颅夹闭后并脑积水发生的独立危险因素为Fisher Ⅳ级［P=0.007，优势比（OR）=17.949，OR 95%置信区间（CI）：2.181～147.682］，LD(P=0.003，OR=4.717，OR 95% CI：1.486～89.027)。ROC曲线分析显示，Fisher Ⅳ级+LD［曲线下面积（AUC）=0.747 8，95%CI：0.644 3～0.851 4，P=0.000 2，PH-L=0.851］。血管内栓塞后并脑积水发生的独立危险因素为Fisher Ⅳ级(P=0.048，OR=3.598，OR 95% CI：1.014～12.768)，Hunt-Hess Ⅲ-V 级(P=0.039，OR=8.610，OR 95% CI：1.113～66.583)。ROC曲线分析显示，Fisher Ⅳ级+ Hunt-Hess Ⅲ-V 级（AUC=0.705 1，95%CI：0.617 5～0.792 6，P=0.000 8，PH-L=0.789）。结论颅内破裂动脉瘤Fisher分级Ⅲ-Ⅳ级患者发生脑积水独立危险因素因不同治疗方式而不同。开颅夹闭和血管内栓塞后并发脑积水的独立危险因素分别为Fisher Ⅳ级、持续LD和Fisher Ⅳ级、Hunt-Hess Ⅲ-Ⅳ级。

Objective To explore the related risk factors of hydrocephalus in Fisher grade Ⅲ-Ⅳ patients. Methods 313 Fisher Ⅲ-Ⅳ patients of ruptured aneurysm treated in the Department of Neurosurgery, General Hospital of Ningxia Medical University from May 2015 to January 2022 were included. The clinical data of two groups of patients with hydrocephalus and non-hydrocephalus according to different treatment methods were collected, and the independent risk factors of hydrocephalus were analyzed by multivariate logistic regression. The predictive model was constructed by independent risk factors, and combined with the receiver operating characteristic(ROC) curve analysis model to predict the value of patients with hydrocephalus. Results Univariate analysis showed that postoperative hydrocephalus in patients with clipping and coiling was associated with Fisher Ⅳ grade(P=0.004), subarachnoid continuous lumbar drainage（LD）(P=0.017), and Hunt-Hess Ⅲ-V grade(P=0.003), Fisher Ⅳ grade(P=0.005), decompressive craniectomy(P=0.042), and pneumonia(P=0.016), respectively. Based on multiple factor analysis, it is concluded that the independent risk factors of hydrocephalus after clipping were Fisher Ⅳ grade［P=0.007, odds ratio(OR)=17.949, OR 95% confidence interval(CI): 2.181-147.682］, and LD(P=0.003, OR=4.717, OR 95% CI:1.486-89.027). ROC curve analysis showed that Fisher Ⅳ grade + LD(AUC=0.747 8, 95% CI: 0.644 3-0.851 4, P=0.000 2, PH-L=0.851). The independent risk factors of hydrocephalus after coiling were Fisher Ⅳ(P=0.048, OR=3.598, OR 95% CI:1.014-12.768) and Hunt Hess Ⅲ-V(P=0.039, OR=8.610, OR 95% CI:1.13-66.583). ROC curve analysis showed that Fisher Ⅳ grade+Hunt Less Ⅲ-V grade(AUC=0.7051, 95% CI:0.617 5-0.792 6, P=0.000 8, PH-L=0.789). Conclusions Different treatment methods can lead to different independent risk factors of hydrocephalus in patients with intracranial ruptured aneurysms of Fisher Ⅲ-Ⅳ grade. The factors of clipping and coiling were Fisher Ⅳ, LD, and Fisher Ⅳ, Hunt Hess Ⅲ-Ⅳ, respectively.