Abstract：
OBJECTIVE: A rupture of the intracranial aneurysm is frequently complicated, with an increase of intracranial pressure (ICP) requiring conservative and/or surgical treatment. We ana- lyzed the risk factors related to the duration of pathologic ICP increase and the relationship be- tween ICP burden and the outcome of subarachnoid hemorrhage (SAH).
METHODS: Consecutive cases with aneurysmal SAH treated at our institution between 01/2003 and 06/2016 were eligible for this study. Different admission variables were evaluated to predict the duration of ICP increase >20 mmHg in univariate and multivariate analyses. The association of the ICP course with SAH outcome parameters (risk of cerebral infarction, in-hospital mortali- ty, and unfavorable outcome at 6 months defined as modified Rankin scale >3) was adjusted for major outcome-relevant confounders.
RESULTS: Of 820 SAH patients, 378 individuals (46.1%) developed at least one ICP increase re- quiring conservative and/or surgical management after aneurysm treatment (mean duration: 1.76 days, range: 1 - 14 days). In the multivariable linear regression analysis, patients\' age (unstand- ardized coefficient [UC]=-0.02, p <0.0001), World Federation of Neurosurgical Societies (WFNS) grade 4-5 at admission (UC=0.71, p <0.004), regular medication with the angiotensin- converting enzyme (ACE) inhibitors (UC=-0.61, p =0.01), and presence of intracerebral hemor- rhage (UC=0.59, p =0.002) were associated with the duration of ICP increase. In turn, patients with longer ICP elevations were at higher risk for cerebral infarction (adjusted odds ratio [aOR]=1.32 per-day-increase, p <0.0001), in-hospital mortality (aOR=1.30, p <0.0001) and un- favorable outcome (aOR=1.43, p <0.0001). SAH patients who underwent primary decompres- sive craniectomy (DC) showed shorter periods of ICP increase than patients with a secondary decompression (mean: 2.8 vs 4.9 days, p <0.0001).
CONCLUSIONS: The duration of ICP increase after aneurysm rupture is a strong outcome predictor and is related to younger age and higher initial severity of SAH. Further analysis of the factors impacting the course of ICP after SAH is essential for the optimization of ICP management and outcome improvement. .
METHODS: Consecutive cases with aneurysmal SAH treated at our institution between 01/2003 and 06/2016 were eligible for this study. Different admission variables were evaluated to predict the duration of ICP increase >20 mmHg in univariate and multivariate analyses. The association of the ICP course with SAH outcome parameters (risk of cerebral infarction, in-hospital mortali- ty, and unfavorable outcome at 6 months defined as modified Rankin scale >3) was adjusted for major outcome-relevant confounders.
RESULTS: Of 820 SAH patients, 378 individuals (46.1%) developed at least one ICP increase re- quiring conservative and/or surgical management after aneurysm treatment (mean duration: 1.76 days, range: 1 - 14 days). In the multivariable linear regression analysis, patients\' age (unstand- ardized coefficient [UC]=-0.02, p <0.0001), World Federation of Neurosurgical Societies (WFNS) grade 4-5 at admission (UC=0.71, p <0.004), regular medication with the angiotensin- converting enzyme (ACE) inhibitors (UC=-0.61, p =0.01), and presence of intracerebral hemor- rhage (UC=0.59, p =0.002) were associated with the duration of ICP increase. In turn, patients with longer ICP elevations were at higher risk for cerebral infarction (adjusted odds ratio [aOR]=1.32 per-day-increase, p <0.0001), in-hospital mortality (aOR=1.30, p <0.0001) and un- favorable outcome (aOR=1.43, p <0.0001). SAH patients who underwent primary decompres- sive craniectomy (DC) showed shorter periods of ICP increase than patients with a secondary decompression (mean: 2.8 vs 4.9 days, p <0.0001).
CONCLUSIONS: The duration of ICP increase after aneurysm rupture is a strong outcome predictor and is related to younger age and higher initial severity of SAH. Further analysis of the factors impacting the course of ICP after SAH is essential for the optimization of ICP management and outcome improvement. .
摘要：
目的：颅内动脉瘤的破裂通常很复杂，颅内压（ICP）升高，需要保守和/或手术治疗。我们分析了与病理性ICP升高持续时间相关的危险因素，以及ICP负担与蛛网膜下腔出血（SAH）结局之间的关系。
方法：2003年1月至2016年6月在我们机构治疗的动脉瘤性SAH连续病例符合本研究的条件。在单变量和多变量分析中评估不同的入院变量以预测ICP升高>20mmHg的持续时间。ICP病程与SAH结局参数（脑梗死风险，在医院里，6个月时的不良结局定义为改良Rankin量表>3），对主要结局相关的混杂因素进行调整。
结果：820例SAH患者，378个人（46.1％）在动脉瘤治疗后出现至少一次ICP增加，需要保守和/或手术治疗（平均持续时间：1.76天，范围：1-14天）。在多元线性回归分析中，患者年龄(未标准化系数[UC]=-0.02，p<0.0001)，世界神经外科学会联合会（WFNS）入院时4-5级（UC=0.71，p<0.004），常规用药与血管紧张素转换酶（ACE）抑制剂（UC=-0.61，p=0.01），和脑内出血（UC=0.59，p=0.002）的存在与ICP升高的持续时间相关。反过来,ICP升高时间较长的患者发生脑梗死的风险较高(调整后比值比[aOR]=1.32/日增加,p<0.0001),住院死亡率（aOR=1.30，p<0.0001）和不良结局（aOR=1.43，p<0.0001）。接受原发性减压骨瓣切除术（DC）的SAH患者的ICP升高时间比接受继发性减压的患者短（平均：2.8vs4.9天，p<0.0001)。
结论：动脉瘤破裂后ICP升高的持续时间是一个很好的预后预测指标，并且与年龄较小和初始严重程度较高的SAH相关。进一步分析影响SAH后ICP病程的因素对于优化ICP管理和改善预后至关重要。。
方法：2003年1月至2016年6月在我们机构治疗的动脉瘤性SAH连续病例符合本研究的条件。在单变量和多变量分析中评估不同的入院变量以预测ICP升高>20mmHg的持续时间。ICP病程与SAH结局参数（脑梗死风险，在医院里，6个月时的不良结局定义为改良Rankin量表>3），对主要结局相关的混杂因素进行调整。
结果：820例SAH患者，378个人（46.1％）在动脉瘤治疗后出现至少一次ICP增加，需要保守和/或手术治疗（平均持续时间：1.76天，范围：1-14天）。在多元线性回归分析中，患者年龄(未标准化系数[UC]=-0.02，p<0.0001)，世界神经外科学会联合会（WFNS）入院时4-5级（UC=0.71，p<0.004），常规用药与血管紧张素转换酶（ACE）抑制剂（UC=-0.61，p=0.01），和脑内出血（UC=0.59，p=0.002）的存在与ICP升高的持续时间相关。反过来,ICP升高时间较长的患者发生脑梗死的风险较高(调整后比值比[aOR]=1.32/日增加,p<0.0001),住院死亡率（aOR=1.30，p<0.0001）和不良结局（aOR=1.43，p<0.0001）。接受原发性减压骨瓣切除术（DC）的SAH患者的ICP升高时间比接受继发性减压的患者短（平均：2.8vs4.9天，p<0.0001)。
结论：动脉瘤破裂后ICP升高的持续时间是一个很好的预后预测指标，并且与年龄较小和初始严重程度较高的SAH相关。进一步分析影响SAH后ICP病程的因素对于优化ICP管理和改善预后至关重要。。
