手术夹闭和血管内栓塞治疗后动脉瘤性蛛网膜下腔出血患者术后肺炎的术前预测因素：一项单中心回顾性研究
Pre-Operative Predictors for Post-Operative Pneumonia in Aneurysmal Subarachnoid Hemorrhage After Surgical Clipping and Endovascular Coiling: A Single-Center Retrospective Study.
作者信息
Yuan Kexin, Li Runting, Zhao Yahui, Wang Ke, Lin Fa, Lu Junlin, Chen Yu, Ma Li, Han Heze, Yan Debin, Li Ruinan, Yang Jun, He Shihao, Li Zhipeng, Zhang Haibin, Ye Xun, Wang Hao, Li Hongliang, Zhang Linlin, Shi Guangzhi, Zhou Jianxin, Zhao Yang, Zhang Yukun, Li Youxiang, Wang Shuo, Chen Xiaolin, Zhao Yuanli, Hao Qiang
机构信息
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
出版信息
Front Neurol. 2022 Jun 24;13:893516. doi: 10.3389/fneur.2022.893516. eCollection 2022.
OBJECTIVE
Postoperative pneumonia (POP) is one of the major complications after aneurysmal subarachnoid hemorrhage (aSAH) associated with postoperative mortality, prolonged hospitalization, and increased medical cost. Early recognition of pneumonia and more aggressive management may improve patient outcomes.
METHODS
We retrospectively reviewed all patients with aSAH who were admitted to our institution between January 2015 and December 2020. Baseline clinical characteristics, imaging data, and inflammatory biomarkers were reviewed. The risk factors derived from multivariate logistic regression of surgical clipping (SC) and endovascular coiling (EC) were analyzed. The area under the receiver operating characteristic (ROC) curve (AUC) was used to calculate each independent predictor's prediction ability.
RESULTS
A total of 843 patients were enrolled. Compared with patients in the EC group, the incidence of POP was higher in the SC group [143/414 (34.54%) vs. 114/429 (26.57%), = 0.015]. In the EC group, multivariate analysis revealed that age [ = 0.001; odds ratio (OR) = 1.04, 95% CI = 1.02-1.07], posterior circulation aneurysms ( = 0.021; OR = 2.07, 95% CI = 1.14-3.83), higher neutrophil (NEUT; < 0.001; OR = 1.13, 95% CI = 1.06-1.21), World Federation of Neurosurgical Societies (WFNS) grade 4 or 5 ( < 0.001; OR = 4.84, 95% CI = 2.67-8.79), modified Fisher Scale (mFS) grade 3 or 4 ( = 0.022; OR = 2.60, 95% CI = 1.15-5.89), and acute hydrocephalus ( = 0.048; OR = 1.74, 95% CI = 1.01-3.00) were independent risk factors for POP. In the SC group, multivariate analysis revealed that age ( = 0.015; OR = 1.03, 95% CI = 1.01-1.05), WFNS grade 4 or 5 ( = 0.037; OR = 1.76, 95% CI = 1.03-3.00), heart disease ( < 0.001; OR = 5.02, 95% CI = 2.03-12.45), higher white blood cell (WBC; < 0.001; OR = 1.13, 95% CI = 1.07-1.20), and mFS grade 3 or 4 ( = 0.019; OR = 2.34, 95% CI = 1.15-4.77) were independent risk factors for POP.
CONCLUSION
Patients treated with SC are more likely to develop POP. Comprehensive preoperative evaluation of patients may help physicians to better predict POP and implement preventive measures to improve outcomes.
目的
术后肺炎（POP）是动脉瘤性蛛网膜下腔出血（aSAH）后的主要并发症之一，与术后死亡率、住院时间延长及医疗费用增加相关。早期识别肺炎并采取更积极的治疗措施可能改善患者预后。
方法
我们回顾性分析了2015年1月至2020年12月期间入住我院的所有aSAH患者。回顾了基线临床特征、影像学数据和炎症生物标志物。分析了手术夹闭（SC）和血管内栓塞（EC）的多因素逻辑回归得出的危险因素。采用受试者操作特征（ROC）曲线下面积（AUC）计算各独立预测因素的预测能力。
结果
共纳入843例患者。与EC组患者相比，SC组POP的发生率更高[143/414（34.54%）对114/429（26.57%），P = 0.015]。在EC组中，多因素分析显示年龄[P = 0.001；比值比（OR）= 1.04，95%置信区间（CI）= 1.02 - 1.07]、后循环动脉瘤（P = 0.021；OR = 2.07，95% CI = 1.14 - 3.83）、中性粒细胞水平较高（NEUT；P < 0.001；OR = 1.13，95% CI = 1.06 - 1.21）、世界神经外科联合会（WFNS）4级或5级（P < 0.001；OR = 4.84，95% CI = 2.67 - 8.79）、改良Fisher分级（mFS）3级或4级（P = 0.022；OR = 2.60，95% CI = 1.15 - 5.89）以及急性脑积水（P = 0.048；OR = 1.74，95% CI = 1.01 - 3.00）是POP的独立危险因素。在SC组中，多因素分析显示年龄（P = 0.015；OR = 1.03，95% CI = 1.01 - 1.05）、WFNS 4级或5级（P = 0.037；OR = 1.76，95% CI = 1.03 - 3.00）、心脏病（P < 0.001；OR = 5.02，95% CI = 2.03 - 12.45）、白细胞水平较高（WBC；P < 0.001；OR = 1.13，95% CI = 1.07 - 1.20）以及mFS 3级或4级（P = 0.019；OR = 2.34，95% CI = 1.15 - 4.77）是POP的独立危险因素。
结论
接受SC治疗的患者更易发生POP。对患者进行全面的术前评估可能有助于医生更好地预测POP并实施预防措施以改善预后。
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