Abstract: Background　Subarachnoid hemorrhage（SAH） is a common emergency of the nervous system，intracranial aneurysm rupture is the first cause of spontaneous SAH，and aneurysm rebleeding is the most common and serious acute complication of aneurysmal subarachnoid hemorrhage（aSAH）.However，there is still no consensus on the risk factors of re-bleeding in aSAH patients.Objective　To analyze the risk factors for rebleeding after aSAH，so as to guide the prevention of rebleeding in patients with aSAH.Methods　A retrospective analysis of the clinical data of 200 patients with aneurysmal subarachnoid hemorrhage admitted in the Fourth Affiliated Hospital of China Medical University from January 2010 to July 2017.Subjects were divided into rebleeding group（n=46） and non-rebleeding group（n=154） according to whether there was rebleeding within 1 month after the initial hemorrhage.Hunt-Hess grade and modified Fisher grade were estimated according to the clinical and imaging features，and Univariate analysis and Multivariate Logistic analysis were used to identify the risk factors of rebleeding.Results　Univariate analysis showed that，there were statistical difference in the average systolic blood pressure，Hunt-Hess grade，modified Fisher grade，diameter of the ruptured aneurysm between two groups（P<0.05），while there were no difference in patients' gender，age，glycemia，white blood cell count，and aneurysm locationwere between two groups（P>0.05）．Multivariate Logistic regression analysis showed that the average systolic blood pressure was not related to rebleeding （P>0.05），and Hunt-Hess grade，modified Fisher grade，diameter of the ruptured aneurysm，and posterior circulation aneurysms were risk factors for rebleeding of aSAH（P<0.05）．Conclusion　Hunt-Hess grade，modified Fisher grade，diameter of the ruptured aneurysm，and posterior circulation aneurysms were risk factors for aneurysm rebleeding，which should be actively prevented.

Key words: Subarachnoid hemorrhage；Aneurysm, ruptured；Intracranial hemorrhages；Root cause analysis

摘要： 背景　蛛网膜下腔出血（SAH）是神经系统的常见急症，颅内动脉瘤破裂是造成自发性SAH的首位病因，而动脉瘤再出血是动脉瘤性SAH（aSAH）最常见、最严重的急性并发症，然而关于aSAH患者再出血危险因素的研究目前仍未达成共识。目的　对aSAH患者再出血的危险因素进行分析，为aSAH患者再出血的预防提供指导。方法　对中国医科大学附属第四医院2010年1月—2017年7月收治的200例aSAH患者的临床资料进行回顾性分析，根据首次出血后1个月内是否发生再出血分为再出血组46例和非再出血组154例，对比分析患者临床指标、Hunt-Hess分级、改良Fisher分级及影像学指标，对发生再出血的影响因素进行单因素分析、多因素Logistic回归分析。结果　单因素分析结果显示两组平均收缩压、Hunt-Hess分级、改良Fisher分级、责任动脉瘤直径比较，差异有统计学意义（P<0.05），两组性别、年龄、血糖水平、白细胞计数、动脉瘤位置比较，差异无统计学意义（P>0.05）。多因素Logistic回归分析结果显示平均收缩压与aSAH患者再出血无关（P>0.05），Hunt-Hess分级、改良Fisher分级、责任动脉瘤直径及后循环动脉瘤是aSAH患者再出血的影响因素（P<0.05）。结论　Hunt-Hess分级、改良Fisher分级、责任动脉瘤直径及后循环动脉瘤是aSAH患者再出血的影响因素，应关注并积极预防以上因素。

关键词: 蛛网膜下腔出血, 动脉瘤, 破裂, 颅内出血, 影响因素分析