Analysis Of Factors Associated With Delayed Cerebral Ischemia After Clipping Of Intracranial Aneurysms In ASAH Patients

Objective:To identify the risk factors for delayed cerebral ischemia（DCI）in patients who have undergone clipping for aneurysmal subarachnoid hemorrhage（a SAH）,so as to facilitate timely assessment of postoperative DCI and reduce the incidence of postoperative DCI,thus largely lowering the mortality and disability rate of a SAH patients and providing evidences for improving the prognosis of a SAH patients.Methods:Clinical data including sex,age,ethnicity,site of aneurysm,length of hospital stay,presence or absence of preoperative hydrocephalus,aneurysm size,Glasgow coma score（GCS）,Hunt-hess grade,modified Fisher scale grade and blood pressure grade at admission,PO₂,PCO₂,blood potassium,blood sodium and blood glucose levels at admission,WBC and neutrophil counts at admission,number of head drainage tubes,duration of head drainage,presence or absence of invasive procedures（tracheotomy,tracheal intubation,urinary catheterization,venous catheterization）,whether nimodipine was used,results of cerebrospinal fluid,urine and sputum cultures,timing of surgery,and whether there was nosocomial infection,etc.,were collected from 136 a SAH patients who underwent aneurysm clipping at Zhangjiajie People’s Hospital from June 2014 to December 2019 for retrospective analyses.Univariate analysis and binary Logistic regression were performed on each indicator to explore the correlation factors for DCI.Results:This study included 136 patients,of whom 39 patients developed DCI,accounting for the incidence of 28.7%.Univariate analysis showed that the development of DCI was correlated with presence or absence of tracheotomy and tracheal intubation,Hunt-hess grade,modified Fisher scale grade,GCS and blood pressure grade at admission,length of hospital stay,blood potassium,blood sodium blood glucose,PO₂ and PCO₂levels at admission,as well as WBC and neutrophil counts at admission（P<0.05）;binary logistic regression analysis showed presence of tracheotomy（OR=4.674,95%CI:1.268-17.237）,high modified Fisher scale grade at admission（OR=1.708,95%CI:1.141-2.556）and low blood potassium at admission（OR=0.389,95%CI:0.155-0.980）to be independent risk factors for DCI following aneurysm clipping（P<0.05）.Conclusions:1.Perioperative tracheotomy,low blood potassium at admission,and high modified Fisher scale grade at admission are predictive of increased risk of DCI in a SAH patients who have undergone clipping surgery.2.Size of aneurysm,GCS,Hunt-hess grade,blood pressure grade,PO₂,PCO₂,blood sodium and blood glucose levels at admission,as well as WBC and neutrophil counts at admission are of positive significance for evaluating the development of DCI in a SAH patients who have undergone clipping surgery.