Qureshi A I, Suarez J I, Bhardwaj A, Yahia A M, Tamargo R J, Ulatowski J A
Division of Neurosciences Critical Care, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Crit Care Med. 2000 Mar;28(3):824-9. doi: 10.1097/00003246-200003000-00035.
Symptomatic vasospasm after subarachnoid hemorrhage (SAH) is associated with a high incidence of permanent disability and death. For early identification of patients who are at risk for poor outcome, we determined the predictors of outcome in patients with symptomatic vasospasm after SAH.
We retrospectively determined the prognostic value of clinical characteristics and computed tomographic scan both at admission and at the time of initiation of hypervolemic and hypertensive therapy.
Neurosciences critical care unit at a University hospital.
A total of 70 consecutive patients who developed symptomatic vasospasm after SAH.
Treatment with oral nimodipine, hypervolemic therapy, and hypertensive therapy. Angioplasty and intra-arterial papaverine were used in patients with vasospasm resistant to standard treatment.
Poor outcome, defined as Glasgow Outcome Scale Score of 3-5 at 2 months or discharge, was observed in 32 (46%) patients. In the logistic regression analysis, a Glasgow Coma Scale (GCS) score of < or =11 (odds ratio, 11.0; 95% confidence interval, 3.6-39.3) and hydrocephalus (odds ratio, 4.3; 95% confidence interval, 1.2-18.2) at the time of initiation of hypervolemic and hypertensive therapy were significantly associated with poor outcome. Poor outcome was observed in 91% of the patients who had both a GCS score of < or =11 and hydrocephalus compared with 15% of patients with a GCS score of >11 and no hydrocephalus at the time of initiation of hypervolemic and hypertensive therapy. A GCS score of < or =11 was also independently associated with length of intensive care unit stay (F ratio = 18.0; p = .0011) and hospital stay (F ratio = 9.2; p = .0034) after initiation of hypervolemic and hypertensive therapy.
The results of this study suggest that outcome in patients with symptomatic vasospasm can be effectively predicted by routinely available information, including GCS score at the time of initiation of hypervolemic and hypertensive therapy. This information can be used for selection and stratification of patients in future treatment studies of patients with symptomatic vasospasm.
蛛网膜下腔出血（SAH）后出现症状性血管痉挛与永久性残疾和死亡的高发生率相关。为了早期识别预后不良的患者，我们确定了SAH后症状性血管痉挛患者的预后预测因素。
我们回顾性地确定了入院时以及开始进行扩容和高血压治疗时临床特征和计算机断层扫描的预后价值。
一所大学医院的神经科学重症监护病房。
共有70例SAH后出现症状性血管痉挛的连续患者。
口服尼莫地平、扩容治疗和高血压治疗。对标准治疗无效的血管痉挛患者采用血管成形术和动脉内注射罂粟碱。
32例（46%）患者预后不良，定义为2个月或出院时格拉斯哥预后量表评分为3 - 5分。在逻辑回归分析中，开始扩容和高血压治疗时格拉斯哥昏迷量表（GCS）评分≤11分（比值比，11.0；95%置信区间，3.6 - 39.3）和脑积水（比值比，4.3；95%置信区间，1.2 - 18.2）与预后不良显著相关。在开始扩容和高血压治疗时，GCS评分≤11分且有脑积水的患者中，91%预后不良，而GCS评分>11分且无脑积水的患者中这一比例为15%。开始扩容和高血压治疗后，GCS评分≤11分也与重症监护病房住院时间（F值 = 18.0；p = 0.0011）和住院时间（F值 = 9.2；p = 0.0034）独立相关。
本研究结果表明，通过常规可得信息，包括开始扩容和高血压治疗时的GCS评分，可以有效预测症状性血管痉挛患者的预后。该信息可用于未来症状性血管痉挛患者治疗研究中的患者选择和分层。
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