血浆儿茶酚胺含量在动脉瘤破裂性蛛网膜下腔出血及其并发神经源性肺.docVIP

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 李瑾 张均 钱健 李启明 顾双双 王路娜 沙杜鹃 (江苏省南京市，南京大学医学院附属鼓楼医院，急诊科，210008) 【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。 【关键词】 动脉瘤性蛛网膜下腔出血；神经源性肺水肿；心电图； Analysis of the possible risk factors and electrocardiographic records of patients with neurogenic pulmonary edema (NPE) in the early stage of aneurismal subarachnoid hemorrhage Li jin, Zhang jun, qian jian, Li qi-ming, Gu shuang-shuang, Wang lu na, Sha du-juan. Department of emergency, affiliated Drum Tower Hospital, Nan jing University Medical School, Nan jing 210008,CHINA [Abstract] 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