朱旭 1于国渊 1王喜旺 1李克芬 1苗燕杰 1张宁1
作者信息
- 1. 056001 河北省邯郸市中心医院神经外二科
- 折叠
摘要
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 pDoC 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 19.65×109/L,respectively.Conclusion Intracranial hematoma,acute hydrocephalus,preoperative blood glucose and white blood cell count are influencing factors for the occurence of pDoC in patients with high Hunt-Hess grade aSAH,providing significant predictive value for pDoC after treatment in these patients.关键词
动脉瘤性蛛网膜下腔出血/急性脑积水/慢性意识障碍/危险因素Key words
Aneurysmal subarachnoid hemorrhage/Acute hydrocephalus/Prolonged disorders of consciousness/Risk factors
