Brouwers P J, Wijdicks E F, Van Gijn J
University Department of Neurology, University Hospital Utrecht, The Netherlands.
Stroke. 1992 Mar;23(3):374-9. doi: 10.1161/01.str.23.3.374.
We sought to determine the contribution of the amount, distribution, and clearance rate of extravasated blood in relation to occurrence of infarction and outcome in patients with aneurysmal subarachnoid hemorrhage.
We prospectively studied 59 consecutive patients with aneurysmal subarachnoid hemorrhage admitted within 72 hours by means of serial computed tomographic scanning, close clinical observation, and assessment of outcome after 3 months.
Infarction occurred in 17 of the 59 patients. The arterial territories involved hardly reflected the distribution of subarachnoid blood in the basal cisterns on computed tomography, and even the side of the infarcts corresponded only weakly with the side on which most extravasated blood was seen. Infarction occurred twice as often in patients with large amounts of subarachnoid blood; this difference was not significant on its own but is in agreement with previous studies. A low clearance rate of cisternal blood was not related to the occurrence of infarction; a relation between clearance rate and poor outcome was largely explained by the amount of subarachnoid blood on the initial computed tomogram and by a low Glasgow Coma Scale score on admission.
The fact that infarction is related to the total amount but not to the distribution or clearance rate of extravasated blood argues against a direct role of extravasated blood and in favor of systemic factors, dependent on the severity of the initial hemorrhage.
我们试图确定动脉瘤性蛛网膜下腔出血患者中，外渗血液的量、分布及清除率与梗死发生及预后的关系。
我们对59例在72小时内入院的连续动脉瘤性蛛网膜下腔出血患者进行了前瞻性研究，采用系列计算机断层扫描、密切临床观察及3个月后预后评估。
59例患者中有17例发生梗死。所累及的动脉区域几乎不能反映计算机断层扫描显示的基底池蛛网膜下腔血液的分布，甚至梗死侧与见到最多外渗血液的一侧仅有微弱对应关系。蛛网膜下腔血液量多的患者梗死发生率高出两倍；这一差异本身并不显著，但与既往研究一致。脑池内血液清除率低与梗死发生无关；清除率与不良预后之间的关系很大程度上可由初始计算机断层扫描上的蛛网膜下腔血液量及入院时低格拉斯哥昏迷量表评分来解释。
梗死与外渗血液的总量有关而非与外渗血液的分布或清除率有关，这一事实不支持外渗血液的直接作用，而支持取决于初始出血严重程度的全身因素。
