Analysis On The Risk Factors Of The Early-stage Vasospasm After Subarachnoid Hemorrhage Of The Spontaneous Intracranial Aneurysm

Objective:This study evaluates the relativity of the risk factors to the early-stage vasospasm after subarachnoid hemorrhage by adopting an analysis method of case review. We further predict the early-stage vasospasm after subarachnoid hemorrhage, providing a clinical treatment basis though the analysis of the risk factors.Methods:According to the diagnosis standard in the“European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage in 2013”,130 Cases with a SAH were recruited from Shanxi Datong Third People’s Hospital from January 2013 to December 2014. All patients were firstly screened by computer tomography angiography(CTA) and then confirmed to be an intracranial aneurysm through digital subtract angiography.We found totally 106 cases. There is still not an uniform criterion for the diagnosis of the a SAH in the research at home and abroad at present. The major diagnosis of the CVS is mainly based on the following aspects: ①a SAH symptom aggravated progressively with a phenomenon of fever and high hemogram after the symptom relieved or disappeared, but there is no evidence of infection; ②Progressive impairment of consciousness; ③Functional deficiency in nerve system, such as dyskinesia or sensory disorder; ④Symptoms of intracranial hypertension, such as headache, vomiting, papilloedema;⑤DSA show CVS; ⑥The blood flow change, arterial parameters varation and the blood flow murmur.The patient can be diagnosed CVS, if itcontains the two of contents above, except secondary bleeding,the hematoma caused by hemorrhage, hydrocephalus and electrolyte disorder, and so on. CVS judgement and severity classification method: CVS degrees are divided into: diffuseness: the partial blood vessel ischemia range in the vicinity of the aneurysms is more than 2cm, among which the diameter of the slight vascular shrinks by a range from 25% to 50%, the serious vascular shrinks more than 50%; peripheral: the partial blood vessel ischemia range at the far-end of the aneurysms is close to 2cm; focal: a single partial ischemia; multi-focal: multiple focal ischemia.Clinical observation indexes: Regression analysis is taken on the 13 factors including the patients age, CT- Fisher classification, history of hypertension, history of diabetes, smoking history, drinking history, blood glucose, low density lipoprotein, Serum calcium, Serum potassium, Serum sodium, Serum magnesium, peripheral white blood cell counting, neutrophil percentage.SPSS19.0 statistical analysis software is applied to statistical analysis. Chi square test or exact probility method is used to analyze the count data; the correlation grade material is used to establish the correlation to early vascular spasm; Risk factors and protective factors of ECVS is analyzed by Logistic analysis. P < 0.05 is regarded to be with the statistical significance in difference.Results:Single factor analysis The age, serum sodium, serum calcium, serum magnesium,blood glucose, peripheral blood leukocyte, neutrophil percentage in the count material have statistical significance(P < 0.05 or P < 0.01). The modified Fisher grade in the count material has a statistical significance(table 1).Correlation analysis The age, peripheral blood leukocyte, neutrophil percentage,modified Fisher grading, rs> 0, illustrate the positive correlation with ECVS(P< 0.01);serum sodium, serum calcium, magnesium, rs< 0, illustrate the negative correlation withECVS(P < 0.05 or P < 0.01).(table 2)Multiple-factor analysis Risk factors and protective factors of ECVS is analyzed by Logistic analysis. Senile patient, high CT-Fisher grade, regression coefficient of serum sodium and peripheral blood leukocyte(b)>0,OR>0,the factors above is the independent risk factors of ECVS occurrence(P<0.05 or P <0.01). Regression coefficient of high serum calcium(b)>0,OR>0 is the independent risk factors of ECVS occurrence(P <0.01).(table3)Conclusions:The age, serum sodium, serum calcium, serum magnesium, blood glucose, peripheral blood leukocyte, neutrophil percentage, modified Fisher grading in the patients of aneurysmal subarachnoid hemorrhage have a correlation with the early vascular spasm, so it can provide a theoretical basis for the prediction of vascular spasm, further to provide a clinical evidence for the treatment of early cerebral vasospasm after subarachnoid hemorrhage.