J Neurosurg:预测aSAH后脑积水的实用工具

2018-07-03 杨中华 脑血管病及重症文献导读

分流依赖性脑积水(Shunt-dependent hydrocephalus,SDHC)是动脉瘤蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)的常见并发症。数据显示其发生率差异很大,介于6.5%到67%之间,与很多潜在的危险因素有关。早期识别和准确识别需要分流的患者有助于降低导管相关脑膜炎,缩短住院时间,降低治疗花费。

分流依赖性脑积水(Shunt-dependent hydrocephalus,SDHC)是动脉瘤蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)的常见并发症。数据显示其发生率差异很大,介于6.5%到67%之间,与很多潜在的危险因素有关。早期识别和准确识别需要分流的患者有助于降低导管相关脑膜炎,缩短住院时间,降低治疗花费。

最近的一项meta分析认为SAHC的危险因素包括(降序):高Fisher分级,急性脑积水(acute hydrocephalus,aHP),脑内出血(ICH),脑室出血(IVH),高Hunt-Hess分级,再出血,后循环动脉瘤,年龄>=60岁,女性。现在已经发表了几个预测SDHC的评分系统。比如,FRI评分(Failure risk index)包括三脑室直径、Hunt-Hess分级、CSF蛋白水平、性别和后循环动脉瘤。但是,该评分并未得到广泛应用。最近有人提出了CHESS评分(chronic hydrocephalus ensuing from SAH score,CHESS),该评分主要是根据多因素分析制定的,以下因素被认为与SDHC有关:Hunt-Hess分级>=4(1分)、后循环破裂动脉瘤(1分)、aHP(4分)、IVH(1分)、以及随访CT发现早期脑梗死(1分)。CHESS>=6分处于SDHC高风险之中(P< 0.0001)。在这个评分系统中,更加强调了aHP的作用。

制定一个相对简单的评分系统将有利于早期预测SDHC。2018年5月来自德国的Dominik Diesing等在JOURNAL OF NEUROSURGERY上发表了他们的研究结果,制订了一套预测SDHC的评分系统SDASH(shunt dependency in aSAH)评分。

他们对回顾性数据进行了多因素分析,发现以下三项参数是SDHC的独立危险因素:aHP,BNI评分>=3,Hunt-Hess >=4级。作者把SDASH评分(1-4分)定义为aHP(计2分),BNI评分>=3分(计1分),Hunt-Hess>=4级(计1分)。他们发现CHESS、BNI和SDASH三套计分系统都能够准确预测慢性脑积水(ORs 1.533 [CHESS], 2.021 [BNI], and 2.496 [SDASH]; p ≤ 0.001)。CHESS和SDASH评分的受试者工作曲线下的面积(Areas under the receiver operating curve,AUROC)相当(分别为0.769和0.785; p = 0.447),但是CHESS和SDASH评分预测SDHC优于BNI分级系统(BNI AUROC 0.649; p = 0.014 and 0.001)。与CHESS和BNI评分相比,SDASH计分的增加与发生SDHC风险增加是一致的。

最终作者认为,新制订了SDASH评分可以可靠地预测SDHC。该预测工具包含的参数较少,与现有的评分工具相比能够更加直观地(more intuitive)预测SDHC。该评分尚需要进一步前瞻性评价。

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    2018-10-25 lvygwyt2781
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    2019-03-04 yese
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    2018-07-05 lsndxfj
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    2018-07-05 zexyw03
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    2018-07-03 医者仁心5538

    学习了

    0

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