动脉瘤性蛛网膜下腔出血患者的肺部并发症:危险因素和对转归的影响

摘要

目的 探讨动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者合并肺部并发症的危险因素及对转归的影响.方法 回顾性纳入2016年1月至2017年12月期间天门市第一人民医院收治的aSAH患者.收集患者人口统计学和基线资料.肺部并发症主要包括肺部感染、急性肺损伤和神经源性肺水肿.在6个月后采用改良Rankin量表评价临床转归,0～3分定义为转归良好,＞3分定义为转归不良.利用多变量logistic回归分析确定合并肺部并发症以及转归不良的独立危险因素.结果 总共纳入230例aSAH患者,平均年龄57岁,男性135例,女性95例.120例(52.2％)合并肺部并发症,其中113例合并医院获得性肺炎,5例合并急性肺损伤,2例合并神经源性肺水肿.172例(74.8％)转归良好,58例转归不良.多变量logistic回归分析显示,Hunt-Hess分级3～5级[优势比(odds ratio,OR)1.500,95％可信区间(confidence interval,CI)1.043～2.159;P=0.029]、Fisher分级3～4级(OR 1.366,95％ CI1.031～1.089;P=0.022)以及气管切开或机械通气(OR1.662,95％ CI1.002 ～2.757;P =0.049)是合并肺部并发症的独立危险因素;Hunt-Hess分级3～5级(OR 1.840,95％ CI 1.590～2.129;P＜0.001)、Fisher分级3～4级(OR 3.522,95％ CI3.056～4.058;P＜0.001)、脑室铸型(OR2.130,95％CI1.258 ～ 3.609;P=0.005)以及肺部并发症(OR1.531,95％ CI1.186～1.975;P=0.001)是转归不良的独立危险因素.结论 较高的Hunt-Hess分级和Fisher分级以及气管切开或机械通气与aSAH患者肺部并发症风险增高相关,肺部并发症的发生对患者临床转归具有不良影响.%Objective To investigate the risk factors for pulmonary complications in patients with aneurysmal subarachnoid hemorrhage (aSAH) and the impact on outcome.Methods Patients with aSAH admitted to the First People's Hospital of Tianmen from January 2016 to December 2017 were enrolled retrospectively.The demographic and baseline data of the patients were collected.Pulmonary complications mainly included pulmonary infection,acute lung injury,and neurogenic pulmonary edema.Clinical outcomes were assessed after 6 months using the modified Rankin scale,0-3 was defined as good outcome and ＞3 was defined as poor outcome.Multivariate logistic regression analysis was used to determine independent risk factors for pulmonary complications and poor outcome.Results A total of 230 patients with aSAH were enrolled,with an average age of 57 years,135 males and 95 females.One hundred and twenty patients (52.2％) complicated with pulmonary complications,113 of them complicated with hospital-acquired pneumonia,5 complicated with acute lung injury,and 2 complicated with neurogenic pulmonary edema.One hundred and seventy-two patients (74.8％) had good outcomes and 58 had poor outcomes.Multivariate logistic regression analysis showed that Hunt-Hess grade 3-5 (odds ratio [OR] 1.500,95％ confidence interval[CI] 1.043-2.159;P=0.029),Fisher grade 3-4 (OR 1.366,95％ CI 1.031-1.089;P=0.022),and tracheotomy or mechanical ventilation (OR 1.662,95％ CI 1.002-2.757;P =0.049) were the independent risk factors for pulmonary complications;Hunt-Hess grade 3-5 (OR 1.840,95％ CI 1.590-2.129;P ＜0.001),Fisher grade 3-4 (OR 3.522,95％ CI 3.056-4.058;P＜0.001),ventricular casting (OR 2.130,95％ CI 1.258-3.609;P=0.005),and pulmonary complications (OR 1.531,95％ CI 1.186-1.975;P=0.001) were the independent risk factors for poor outcome.Conclusions Higher Hunt-Hess and Fisher grades and tracheotomy or mechanical ventilation were associated with the increased risk of pulmonary complications in patients with aSAH.The occurrence of pulmonary complications had adverse effects on the clinical outcomes of patients.