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Abstract：
Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid haemorrhage (aSAH) is a singular pathological entity necessitating early diagnostic approaches and both prophylactic and curative interventions. This retrospective before-after study investigates the effects of a management strategy integrating perfusion computed tomography (CTP), vigilant clinical monitoring and standardized systemic administration of milrinone on the occurrence of delayed cerebral infarction (DCIn). The \"before\" period included 277 patients, and the \"after\" one 453. There was a higher prevalence of Modified Fisher score III/IV and more frequent diagnosis of vasospasm in the \"after\" period. Conversely, the occurrence of DCIn was reduced with the \"after\" management strategy (adjusted OR 0.48, 95% CI [0.26; 0.84]). Notably, delayed ischemic neurologic deficits were less prevalent at the time of vasospasm diagnosis (24 vs 11%, p = 0.001 ), suggesting that CTP facilitated early detection. In patients diagnosed with vasospasm, intravenous milrinone was more frequently administered (80 vs 54%, p < 0.001 ) and associated with superior hemodynamics. The present study from a large cohort of aSAH patients suggests, for one part, the interest of CTP in early diagnosis of vasospasm and DCI, and for the other the efficacy of CT perfusion-guided systemic administration of milrinone in both preventing and treating DCIn.
摘要：
动脉瘤性蛛网膜下腔出血（aSAH）后的迟发性脑缺血（DCI）是一种独特的病理实体，需要早期诊断方法以及预防性和治愈性干预措施。这项回顾性的前后研究调查了整合灌注计算机断层扫描（CTP）的管理策略的效果。警惕临床监测和规范全身给药米力农对迟发性脑梗死（DCIn）的发生。“之前”期间包括277名患者，和“后”一个453。在“后”期间，改良Fisher评分III/IV的患病率更高，并且血管痉挛的诊断频率更高。相反，采用“后”管理策略后,DCIn的发生率降低(校正OR0.48,95%CI[0.26;0.84]).值得注意的是,在血管痉挛诊断时，迟发性缺血性神经功能缺损的发生率较低(24vs11%，p=0.001),表明CTP有助于早期检测。在诊断为血管痉挛的患者中，静脉注射米力农更频繁(80vs54%，p<0.001）并与优越的血液动力学相关。来自大量aSAH患者的研究表明，有一部分,CTP对血管痉挛和DCI的早期诊断的兴趣，以及CT灌注引导全身给药米力农在预防和治疗DCin方面的功效。
