背景:动脉瘤性蛛网膜下腔出血(aSAH)患者给予钙通道阻滞剂(CCB)以预防脑血管痉挛。我们假设损伤前使用抗高血压药可以预防血管痉挛。尚不清楚院内CCB启动的时机是否会影响该人群的血管痉挛风险。
方法:这项回顾性队列研究包括在综合卒中中心(1/18-11/21)的aSAH患者(≥18y/o)。服用院前降压药的患者[CCB,比较了血管紧张素转换酶(ACE)抑制剂或血管紧张素II受体阻滞剂(ARB)]。结果按接受血管痉挛预防的患者(“院内CCBs”)≤1.2h与距离到达>1.2小时。结果包括血管痉挛,住院时间(LOS),和死亡率。
结果:在251名患者中,18%的人服用院前降压药。患者在基线特征方面具有可比性。与院前降压药相比,血管痉挛的发生率没有差异。对于那些接受院前降压药的人来说,发生血管痉挛的患者的住院CCB时间明显长于未发生血管痉挛的患者(1.2vs.4.9h,分别,p=0.02)。对于那些接受院前降压药的人来说,在到达后1.2小时内接受院内CCB与血管痉挛率显着降低相关(6%vs.39%,p=0.03)和LOS(14vs.20d,p=0.01)与接收>1.2小时到达的住院CCB相比,分别。死亡率(50%vs.26%,p=0.06)组间统计学相似,分别。在未接受院前降压药的患者中未观察到这些结果。住院CCB开始的时间对血管痉挛没有影响(p=0.23),死亡(p=0.08),或LOS(p=0.31),适用于未接受院前降压药的患者。
结论:提高院前降压药患者的院内CCB启动效率可能会减少血管痉挛的发生并导致LOS缩短。
BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) patients are given calcium channel blockers (CCBs) to prevent brain vessel vasospasm. We hypothesized that preinjury antihypertensive use may protect against
vasospasm. It remains unclear whether the timing of in-hospital CCB initiation affects the
vasospasm risk in this population.
METHODS: This retrospective cohort study included aSAH patients (≥18 y/o) at a Comprehensive Stroke Center (1/18-11/21). Patients taking prehospital antihypertensives [CCBs, Angiotensin-converting enzyme (ACE) inhibitors or Angiotensin II receptor blockers (ARBs)] were compared to those who were not. Results were stratified by patients receiving
vasospasm prophylaxis (\'in-hospital CCBs\') ≤1.2 h of arrival vs. >1.2 h from arrival. Outcomes included
vasospasm, hospital length of stay (LOS), and mortality.
RESULTS: Of 251 patients, 18% were taking prehospital antihypertensives. Patients were comparable in baseline characteristics. There was no difference in the rate of
vasospasm when compared by prehospital antihypertensive use. For those on prehospital antihypertensives, the time to in-hospital CCBs was significantly longer for patients who developed vasospasm than for those who did not (1.2 vs. 4.9 h, respectively, p = 0.02). For those on prehospital antihypertensives, receipt of in-hospital CCBs within 1.2 h of arrival was associated with a significantly lower vasospasm rate (6% vs. 39%, p = 0.03) and LOS (14 vs. 20 d, p = 0.01) when compared to receiving in-hospital CCBs > 1.2 h of arrival, respectively. The mortality rate (50% vs. 26%, p = 0.06) was statistically similar between groups, respectively. These results were not observed among patients who were not on prehospital antihypertensives. The timing to in-hospital CCB initiation had no effect on vasospasm (p = 0.23), death (p = 0.08), or LOS (p = 0.31) for patients not on prehospital antihypertensives.
CONCLUSIONS: Enhancing the efficiency of in-hospital CCB initiation for patients on prehospital antihypertensives may decrease the occurrence of vasospasm and lead to a shorter LOS.