背景:动脉瘤性蛛网膜下腔出血(aSAH)仍然是一个毁灭性的诊断。已知不良结果高度依赖于初始神经状态。我们的目标是确定其他参数,这些参数有利于aSAH患者的并发症风险和不良预后,并且最初具有良好的神经状况。
方法:包括2003年1月至2016年6月在我院连续治疗的aSAH病例,最初的世界神经外科学会联合会I-III级。关于人口特征的数据,既往病史,初始aSAH严重程度,收集aSAH后的功能结果。研究终点是脑梗死的发生,住院死亡率,aSAH后6个月的不良结局(改良Rankin量表>3)。
结果:在最后一组(n=582)中,脑梗塞的发生率,住院死亡率,不良结局为35.1%,8.1%,和17.6%。脑梗死的风险与急性脑积水的存在独立相关(校正比值比[aOR]=2.33,p<0.0001),动脉瘤夹闭(aOR=1.78,p=0.003),与尼莫地平联合使用钙通道阻滞剂(aOR=2.63,p=0.002)。患者年龄(>55岁,OR=4.24,p<0.0001),急性脑积水(aOR=2.43,p=0.036),剪裁(aOR=2.86,p=0.001)预测住院死亡率。与6个月时不良结局相关的基线特征是年龄(aOR=2.77,p=<0.0001),FisherIII-IV级(aOR=2.81,p=0.016),急性脑积水(aOR=2.22,p=0.012),削波(AOR=3.98,p<0.0001),入院C反应蛋白>1mg/dL(aOR=1.76,p=0.035),和治疗间隔(aOR=0.64每5年间隔,p=0.006)。
结论:尽管脑梗死是aSAH患者的常见并发症,但初始临床条件良好,>80%的这些患者显示良好的长期结果。了解与结果相关的基线特征可能有助于减少对最初出血事件耐受良好的aSAH患者的进一步并发症和不良结局的负担。
BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) remains a devastating diagnosis. A poor outcome is known to be highly dependent on the initial neurological status. Our goal was to identify other parameters that favor the risk of complications and poor outcome in patients with aSAH and initially favorable neurologic status.
METHODS: Consecutive aSAH cases treated at our hospital between 01/2003 and 06/2016 with the initial World Federation of Neurosurgical Societies grades I-III were included. Data on demographic characteristics, previous medical history, initial aSAH severity, and functional outcome after aSAH were collected. The study endpoints were the occurrence of cerebral infarcts, in-hospital mortality, and unfavorable outcome at 6 months after aSAH (modified Rankin scale > 3).
RESULTS: In the final cohort (n= 582), the rate of cerebral infarction, in-hospital mortality, and unfavorable outcome was 35.1%, 8.1%, and 17.6% respectively. The risk of cerebral infarction was independently related to the presence of acute hydrocephalus (adjusted odds ratio [aOR]=2.33, p<0.0001), aneurysm clipping (aOR=1.78, p=0.003), and use of calcium channel blockers concomitant to nimodipine (aOR=2.63, p=0.002). Patients\' age (>55 years, aOR=4.24, p<0.0001), acute hydrocephalus (aOR=2.43, p=0.036), and clipping (aOR=2.86, p=0.001) predicted in-hospital mortality. Baseline characteristics associated with unfavorable outcome at 6 months were age (aOR=2.77, p=<0.0001), Fisher grades III-IV (aOR=2.81, p=0.016), acute hydrocephalus (aOR=2.22, p=0.012), clipping (aOR=3.98, p<0.0001), admission C-reactive protein>1mg/dL (aOR=1.76, p=0.035), and treatment intervals (aOR=0.64 per-5-year-intervals, p=0.006).
CONCLUSIONS: Although cerebral infarction is a common complication in aSAH individuals with favorable initial clinical condition, >80% of these patients show favorable long-term outcome. The knowledge of outcome-relevant baseline characteristics might help to reduce the burden of further complications and poor outcome in aSAH patients who tolerated the initial bleeding event well.