动脉瘤性蛛网膜下腔出血早期并发神经源性肺水肿的相关危险因素分析
Analysis of the possible risk factors and electrocardiographic records of patients with neurogenic pulmonary edema (NPE) in the early stage of aneurismal subarachnoid hemorrhage

李瑾.动脉瘤性蛛网膜下腔出血早期并发神经源性肺水肿的相关危险因素分析[J].内科急危重症杂志,2016,22(3):

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英文关键词:Neurogenic pulmonary edema Aneurysmal subarachnoid hemorrhage Electrocardiographic

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作者	单位	E-mail
李瑾	南京鼓楼医院	njlijin1987@163.com

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中文摘要:

目的分析动脉瘤性蛛网膜下腔出血（aneurismal subarachnoid hemorrhage，SAH）早期并发神经源性肺水肿（neurogenic pulmonary edema，NPE）患者的相关危险因素和心电图。方法选择2009年3月至2014年3月我院收治的206例动脉瘤破裂蛛网膜下腔出血患者，根据是否并发NPE分为NPE组和非NPE组，比较两组在年龄、性别、基础疾病、平均动脉压、心率、病情严重程度、动脉瘤在Willis动脉环所处位置、心电图异常等方面的差异；结果 NPE组与非NPE组在年龄、性别、基础疾病、平均动脉压、心率等方面没有差异（P＞0.05）。和非NPE组相比，NPE组具有更高的Hunt-Hess分级、Fish分级和表现出更多的心电图异常（P＜0.05）。当动脉瘤位于后循环时，NPE的发生率显著高于前循环（P＜0.05）。在所有SAH中约80%心电图有异常表现（81/101），对异常心电图进行分析时，我们发现T波倒置和非特异性ST-T改变在NPE组的发生率更高（P＜0.05）。采用逐步logistic回归法发现Fish分级Ⅲ-Ⅳ级组、后循环动脉瘤及非特异性ST-T改变为NPE的危险因素（P＜0.05）。结论在SAH发病初期，CT评估的出血量、破裂动脉瘤的位置和心电图异常表现（尤其是非特异性ST-T改变）可能有助于预测并早期识别NPE的发生。

英文摘要:

Objective To analyze the possible risk factors and electrocardiographic(ECG) records of patients with neurogenic pulmonary edema (NPE) in the early stage of aneurismal subarachnoid hemorrhage (SAH).Methods 206 patients with aneurismal subarachnoid hemorrhage were be collected in our hospital from the March 2009 to March 2014,divided into two groups: NPE group and non-NPE group,compared in in age,gender,prior comorbidity,mean arterial pressure,heart rate,the severity of the disease,the location of artery aneurysms in Willis arterial circle,and ECG abnormalities.Result There were no significant difference in age, gender, prior comorbidity, mean arterial pressure and heart rate（P＞0.05）.Compared to non-NPE group, NPE group had a higher grade of Hunt-Hess and Fish grade and had more ECG abnormalities (P < 0.05). When the aneurysm was located in the posterior circulation, the incidence of NPE was significantly higher than that in the anterior circulation (P < 0.05). About 80% patients in all SAH had ECG abnormalities(81/101), while the incidence rates of nonspecific ST-T changes and T-wave inversion are significantly higher (P < 0.05) in the NPE group. The Fisher grade Ⅲ - Ⅳ,aneurysm located in posterior circulation and nonspecific ST-T changes were the independent factors for NPE after logistic regression analysis(P < 0.05). Conclusion Rate of hemorrhage in CT,location of aneurysm and ECG abnormalities (especially nonspecific ST -orT-wave changes) may had contribution to predict and identificate the development of NPE in the early stage of SAH.