Risk Factors Of Early Cerebral Ischemia After Rupture Of Intracranial Aneurysm And Its Influence On Complications And Clinical Prognosis

Objective: Intracranial aneurysm(IA)is a kind of cerebrovascular disease.Once rupture threatens life,patients with cerebral ischemia have worse initial clinical manifestations and more severe disease.The purpose of this study was to investigate the risk factors of early cerebral ischemia(ECI)after IA rupture,and the complications and prognosis.To prevent and treat ECI,reduce complications,and improve prognosis,provide some suggestions and references.Methods: Collect clinical data of patients with IA rupture who underwent surgery in our department from July 2018 to December 2019,and implement retrospective analysis.According to the paients’ NHISS score at admission,they are divided into ECI group and non-ECI group.The two groups of basic data,clinical and imaging classification,laboratory tests and aneurysm characteristics were compared.It is speculated that the factors that may cause ECI.Then,the prognosis and complications of the two groups of patients were compared.Followed up for 6 months,the patients were divided into a good prognosis group(0-2 points)and a poor prognosis group(3-6 points)based on the mRS score.Their baseline data,test results,aneurysm data,surgical methods,and timing of surgery were compared.SPSS 17.0 was used to analyze the data.Results: Comparison of Hunt-Hess rating,smoking history,modified Fisher rating,hypertension,white blood cell level,heavy drinking,fibrinogen,diabetes,middle cerebral artery(MCA)aneurysm and WFNS rating in ECI and non-ECI group,and the difference was statistically significant(P<0.05).Sex,age,lymphocytes,hemoglobin,sodium,potassium,calcium ion concentration,triglycerides,plasma blood sugar,aneurysm size,cholesterol,aneurysm morphology and hyperlipidemia were compared,and the differences no statistical significant(P>0.05).Logistic regression analysis manifested that the modified Fisher rating Ⅲ-Ⅲ,MCA,Hunt-Hess rating Ⅲ-Ⅲ were independent risk factors for ECI(P<0.05).The proportion of poor prognosis and death in ECI group was higher than that in non-ECI group(P<0.05).Comparing the complications,the incidence of pulmonary infection,deep vein thrombosis,CVS,cerebral edema and DCI in the ECI group was higher than that in the non-ECI group(P<0.05).There was no statistical difference between the two groups in rerupted aneurysm,hydrocephalus,affective disorder,urinary tract infection(P>0.05).Overall prognosis comparison,there was a statistical difference in ECI,CVS,smoking history,WFNS rating,lung infection,Hunt-Hess rating,fibrinogen,modified Fisher rating,plasma blood glucose,reruptured aneurysm,DCI,cerebral edema,deep vein thrombosis and the history of heavy drinking(P<0.05).The aneurysm location and size,urinary tract infection,timing of surgery,sex,serum sodium,age,serum potassium,history of diabetes,aneurysm morphology,history of hypertension,lymphocytes,hydrocephalus,history of hyperlipidemia,white blood cells,surgical methods,hemoglobin,affective disorders,serum calcium and triglycerides,cholesterol in the two groups had no statistically significant(P>0.05).Logistic regression analysis revealed that elevated plasma blood glucose,Hunt-Hess grade Ⅲ～Ⅲ,ECI,re-ruptured aneurysm,CVS,DCI,and lung infection were independent risk factors for poor prognosis with IA rupture(P<0.05).Conclusion: Modified Fisher rating Ⅲ to Ⅳ,MCA,Hunt-Hess rating Ⅲ to Ⅴ were independent risk factors for ECI after IA rupture.Patients in the ECI group have a worse prognosis and higher mortality.The incidence of complications such as cerebral edema,CVS,deep vein thrombosis,DCI and pulmonary infection in the ECI group was higher than that in the non-ECI group.These complications should be actively prevented,early identified and treated.Hunt-Hess grade Ⅲ～Ⅲ,elevated plasma blood glucose,ECI,re-ruptured aneurysm,CVS,DCI,and lung infection are independent risk factors for poor prognosis in patients with IA rupture.