摘要
目的探讨颅内破裂动脉瘤开颅夹闭术后并发肺炎的危险因素。方法回顾性分析2017年1月1日至2018年12月1日开颅夹闭术治疗的114例颅内破裂动脉瘤的临床资料。采用多因素logistic回归分析检验危险因素。结果114例中,36例(31.5%)发生肺炎。多因素logistic回归分析发现术前Hunt-Hess分级4~5级、术中出血量大、术后当天血红蛋白水平低是术后发生肺炎的独立危险因素(P<0.05)。ROC曲线分析结果显示术中出血量为325ml、术后当天血红蛋白水平为106g/L是术后肺炎的最佳判别界值。结论对开颅夹闭术治疗颅内破裂动脉瘤,病情重、术中出血量大的病人,术后发生肺炎风险明显增加,临床应注意防治。
Objective To analyze the high risk factors related to pneumonia after clipping of aneurysms in the patients with aneurismal subarachnoid hemorrhage(aSAH).Methods Of 114 patients with aSAH who underwent the clipping of aneurysms from January 1,2017 to December 1,2018 in our department,36 had postoperative pneumonia(PPA)and 78 not.The factors related to PPA were statistically analyzed.Results The univariate analysis showed that the factors related to PPA included the hypertension history,preoperative Hunt-Hess grade and Fisher grade,intraoperative aneurismal rupture,decompressive craniectomy,operation duration,intraoperative bleeding volume,intraoperative transfusion of blood and hemoglobin level and plasma albumin level on the postoperative day(P<0.05).The multivariate logistic regression analysis showed that the risk factors related to PPA included the preoperative Hunt-Hess grades 4~5,large volume of bleeding during the operation and low level of hemoglobin on the postoperative day(P<0.05).The receiver operating characteristic curve calculated that the more volume of intraoperative bleeding than 325 ml,and the lower plasma hemoglobin level than 106 g/L on the postoperative day were the discriminant threshold for the occurrence of postoperative pneumonia.Conclusion The preoperative Hunt-Hess grades 4~5,more volume of intraoperative hemorrhage than 325 ml and lower plasma hemoglobin level than 106 g/L on the postoperative day may indicate an increase in the incidence of PPA in the patients with aSAH undergoing the clipping of aneurysms.
作者
汪峰
姚声涛
王小强
余国清
高扬
王晓江
WANG Feng;YAO Sheng-tao;WANG Xiao-qiang;YU Guo-qing;GAO Yang;WANG Xiao-jiang(Department of CerebrovascularDisease,Affiliated Hospital,Zunyi Medical University,Zunyi 563000,China)
出处
《中国临床神经外科杂志》
2019年第10期589-591,共3页
Chinese Journal of Clinical Neurosurgery
关键词
颅内破裂动脉瘤
开颅夹闭术
术后肺炎
危险因素
Aneurysmal subarachnoid hemorrhage
Postoperative pneumonia
Aneurysm clipping
Risk factors
