轻型动脉瘤性蛛网膜下腔出血介入治疗术后早期认知障碍的危险因素分析

Analysis of risk factors for early cognitive impairment after endovascular treatment for mild aneurysmal subarachnoid hemorrhage

摘要:

目的 探索轻型动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage，ASAH）患者介入治疗术后早期认知障碍的危险因素。方法 回顾性收集2015年12月至2021年12月轻型ASAH介入治疗术后患者80例，分别于术后1个月、术后3个月随访简易智力状态检查量表（mini-mental state examination，MMSE）及改良Rankin量表（modified Rankin scale，mRS）评分，将患者分为认知正常组及认知障碍组，详细收集2组患者的临床基线资料，单因素及多因素分析认知障碍的危险因素。结果 80例患者中，术后1个月有41例存在认知障碍，占总人数的51.25%。单因素分析显示受教育程度（P=0.000）、年龄（P=0.020）、入院时改良Fisher分级（modified Fisher scale，mFS）（P<0.001）、Hunt-Hess分级（P<0.006）、动脉瘤部位（P=0.023）、合并脑室出血（P=0.043）是术后认知障碍的危险因素（P<0.05）；多因素分析显示mFS、动脉瘤部位、Hunt-Hess分级及合并脑室出血是术后认知障碍的独立危险因素（P<0.05）。术后3个月随访，患者认知功能均恢复正常。结论 轻型ASAH患者介入治疗术后1个月认知障碍的发生率为51.25%；受教育程度、年龄、mFS、Hunt-Hess分级、动脉瘤部位、合并脑室出血是术后认知障碍的危险因素；mFS、动脉瘤部位、Hunt-Hess分级及合并脑室出血是认知障碍的独立危险因素。

Abstract:

Objective To explore the risk factors for early impairment in patients with mild aneurysmal subarachnoid hemorrhage（ASAH） after endovascular treatment.Methods From a retrospectively collected institutional database，we investigated 80 mild ASAH patients who had endovascular treatment between December 2015 and December 2021. All patients were followed up with the mini-mental state examination（MMSE） and modified Rankin scale（mRS） at one month and three months after endovascular treatment respectively. The patients were classified into normal group and cognitive impairment group according to cognitive status. The clinical baseline data of the two groups of patients were collected and the risk factors of cognitive impairment were analyzed by univariate and multivariate analysis.Results Among the 80 patients，41 had cognitive impairment one month after treatment，accounting for 51.25% of the total number. The univariate analysis of the risk factors for cognitive impairment showed that education level（P=0.000），age（P=0.020），modified Fisher scale（mFS） at admission（P<0.001），Hunt-Hess grade（P<0.006），location of aneurysm（P=0.023），intraventricular hemorrhage（P=0.043） were risk factors for cognitive impairment； the multivariate analysis showed that the mFS，the location of aneurysm，Hunt-Hess scale and intraventricular hemorrhage were independent risk factors for postoperative cognitive impairment（P<0.05），and the cognitive function of all patients returned to normal 3 months after surgery.Conclusion This study found that the incidence of cognitive impairment at 1 month after endovascular treatment for mild ASAH patients was 51.25%. Education level，age，mFS at admission，Hunt-Hess grade，the location of aneurysm，intraventricular hemorrhage are risk factors for cognitive impairment after the surgery. mFS，aneurysm location，Hunt-Hess grade，and intraventricular hemorrhage are independent risk factors for cognitive impairment.