| Objective: To investigate the clinical characteristics and high risk factorsof symptomatic delayed cerebral vasospasm following aneurismalsubarachnoid hemorrhage of Hunt-Hess grade Ⅰ-Ⅱ for prevention andtreatment of the vasospasm by retrospective clinical analysis.Methods:(1) Material: The study was finished by retrospective analysisof377cases presenting Hunt-Hess grade Ⅰ-Ⅱ from839cases ofaneurismal subarachnoid hemorrhage in the Second Affiliated Hospital toHebei Medical University from January,2004to July,2011. It was describedthat clinical present of symptomatic delayed cerebral vasospasm for51out of377cases and completed that probable risk factors such as sex, age, onsetseason, the first symptom, Glasgow Coma Scale (GCS) score on admission,Hunt-Hess grade, hypertension, smoking, drinking, family history, time fromonset to admission, location, size, amount and rupture times of aneurysms andtime of operation by Univariate Analysis, Multivariate Logistic RegressionAnalysis; respectively.(2)The criteria of symptomatic delayed cerebralvasospasm (SDCVS):①there were deterioration and aggravation, or withfever, increased hemogram except of infection after clinical presents wereimproved or stable during4-12days after subarachnoid hemorrhage.②Consciousness fluctuated: that was from consciousness to somnolence orsopor, or from coma to consciousness and then to coma.③According todifferent position of cerebral vasospasm, there was focal neurolocation signsuch as hemiplegia, aphasia, apraxia. The diagnosis of SDCVS was at leastaccorded with one of the above standards, and recurrent bleeding, intracranialhematoma, infection, directed operative injury (clipping feeding arteries orparent arteries), hydrocephalus, electrolyte disorder and other reasons were eliminated.(3) Description and statistics of data: measurement data wereexpressed as Mean±SD, and were analyzed by t test, enumeration data weredescribed with constituent ratio and ratio, and were analyzed by chi-squaretest and Fisher's exact test, multivariate analysis was carried out bynon-conditional logistic regression, The results were statistically analyzed bySPSS19.0software. Size of test was0.05.Result:1377patients with Hunt-Hess grade Ⅰ-Ⅱ after a-SAH admitted to theSecond Affiliated Hospital of Hebei Medical University from January,2004toJuly,2011were collected in this study.51patients with the age from18to76and an average age of58.08±10.34were found to have SDCVS(13.53%),including18males with an average age of53.44±11.89, and33females with55.97±9.47.251patient with Hunt-Hess grade Ⅰ-Ⅱ after a-SAH were found to haveSDCVS, and sixes clinical symptoms were contained.The first,consciousnessand coma in10patients(19.61%) were deteriorated; the second, hemiplegia ormuscle weakness in21cases(41.18%); the third, speech dysfunction in4cases(7.84%); the forth, hemiplegia and speech dysfunction in6patients (11.76%);the fifth, consciousness deteriorated and hemiplegia in6cases (11.76%); thelast, other symptom (unknown high fever and diffuse encephalic swelling etc)in4patient (7.84%).3Univariate analysisAge: univariate analysis of classification variables showed that therewere significant difference among young group(≤44years), adult group(45-59years) and senior group(≥60years)(χ~2=15.286, P=0.000), and the SDCVSrate was3.4%,17.3%and25.5%respectively. Hunt-Hess grade: univariateanalysis of classification variables showed that there were significantdifference between Hunt-Hess grade Ⅰand Ⅱ(χ~2=4.627, P=0.031), and theSDCVS rate was11.9%and22.4%respectively. Time of operation: univariateanalysis of classification variables showed that there were remarkabledifference among early operation group(with3days), intermediate surgery group(between3and10days) and late operation group (in10days)(χ~2=7.702,P=0.021), and the SDCVS rate was16.5%,18.4%and7.7%respectively. However, the other factors showed that there were no statisticalsignificant difference.4Multivariate logistic regression analysisMultivariate logistic regression analysis was done for11variablesmentioned above related risk factors in patient with Hunt-Hess grade ⅠandⅡa fter a-SAH. At last, only age and time of operation were independent riskfactors to SDCVS. Age (regression coefficient=0.861, OR=1.491, P=0.000)and time of operation (regression coefficient=0.861, OR=1.491, P=0.000)were significant difference. Multivariate logistic regression analysis showedthat age and time of operation were high risk factors in SDCVS.Conclusion: We found that the incidence of SDCVS was13.5％inpatient with Hunt-HessⅠ-Ⅱgrade after a-SAH. And hemiplegia or muscleweakness were main clinical manifestations, age and time of operation wereindependent high risk factors for SDCVS．... |
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