Xu Xiaomei, Yang Hongqiao, Wang Xinyang, Wang Li, Wang Yuhai
Department of Neurosurgery, The 904(th) Hospital of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, China.
Department of Neurosurgery, The 904(th) Hospital of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, China; Department of Neurosurgery, The Affiliated Lihuili Hospital of Ningbo University, Zhejiang, China.
World Neurosurg. 2024 Nov;191:e594-e606. doi: 10.1016/j.wneu.2024.09.004. Epub 2024 Sep 11.
In poor-grade aneurysm subarachnoid hemorrhage (PaSAH), the use of external ventricular drainage (EVD) may be closely related to the occurrence of shunt-dependent hydrocephalus (SDHC). The purpose of this study was to investigate the effect of EVD on SDHC and prognosis after microsurgically clipping patients with PaSAH.
The clinical data of 99 patients with PaSAH admitted to the 904th Hospital of People's Liberation Army from October 2011 to December 2020 were analyzed retrospectively. Univariate and multivariate logistic regression analyses were used to clarify the relationship between EVD implantation and its drainage volume and SDHC after PaSAH. Receiver operating characteristic curves were plotted to compare the prognostic efficiency of different drainage volumes on SDHC. Modified Poisson regression analysis was used to determine the effect of SDHC on prognosis after PaSAH.
EVD implantation increased the risk of SDHC (odds ratio = 6.715, 95% confidence interval 1.120-40.248, P = 0.037). The increased drainage volume on day 1, mean daily drainage volume within 2 days, and average within 3 days increased the risk of SDHC. EVD drainage volume on the first postoperative day has a good predictive ability for SDHC after PaSAH, with an area under the curve of 0.829 (95% confidence interval 0.731-0.928); the optimal cut-off value was 208 ml, with a sensitivity of 79.4%, a specificity of 81.6%, and a Youden index of 0.61. The occurrence of SDHC after aneurysm clipping significantly increases the risk of poor prognosis of PaSAH.
EVD implantation is an independent risk factor for SDHC after PaSAH, and a large drainage volume in the first 3 days after EVD implantation is an independent risk factor for SDHC after PaSAH. The drainage volume on the first day after surgery is the best predictor of SDHC after PaSAH. SDHC after PaSAH is the strongest independent risk factor for poor prognosis and prolongs hospital stay.
在低级别动脉瘤性蛛网膜下腔出血（PaSAH）中，使用外部脑室引流（EVD）可能与分流依赖性脑积水（SDHC）的发生密切相关。本研究的目的是探讨EVD对PaSAH患者显微手术夹闭后SDHC及预后的影响。
回顾性分析2011年10月至2020年12月解放军第904医院收治的99例PaSAH患者的临床资料。采用单因素和多因素逻辑回归分析，阐明EVD植入及其引流量与PaSAH后SDHC之间的关系。绘制受试者工作特征曲线，比较不同引流量对SDHC的预后预测效能。采用修正泊松回归分析，确定SDHC对PaSAH后预后的影响。
EVD植入增加了SDHC的风险（比值比=6.715，95%置信区间1.120-40.248，P=0.037）。术后第1天引流量增加、2天内平均每日引流量增加以及3天内平均引流量增加均增加了SDHC的风险。术后第1天的EVD引流量对PaSAH后SDHC具有良好的预测能力，曲线下面积为0.829（95%置信区间0.731-0.928）；最佳截断值为208 ml，敏感性为79.4%，特异性为81.6%，约登指数为0.61。动脉瘤夹闭后SDHC的发生显著增加了PaSAH预后不良的风险。
EVD植入是PaSAH后SDHC的独立危险因素，EVD植入后前3天的大量引流量是PaSAH后SDHC的独立危险因素。术后第1天的引流量是PaSAH后SDHC的最佳预测指标。PaSAH后的SDHC是预后不良和延长住院时间的最强独立危险因素。
