Rosen David S, Amidei Chris, Tolentino Jocelyn, Reilly Christopher, Macdonald R Loch
Section of Neurosurgery, Department of Surgery, University of Chicago Medical Center and Pritzker School of Medicine, Chicago, Illinois 60637, USA.
Neurosurgery. 2007 Feb;60(2):259-66; discussion 266-7. doi: 10.1227/01.NEU.0000249271.56816.03.
Cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) is associated with the volume and location of subarachnoid blood clots. Factors that influence the volume of SAH have seldom been studied.
Two independent sets of data were analyzed. Data from 3028 patients with SAH enrolled in four clinical trials of the drug tirilazad were analyzed in addition to data from 74 patients with SAH who underwent digital volumetric analysis of admission computed tomographic scans to determine the subarachnoid clot volume. In the smaller sample of 74 patients, aneurysm width, length, neck size, aspect ratio, and volume were measured on diagnostic cerebral angiograms. Statistical inference bearing on the question of what factors are associated with clot volume was derived by univariate methods, including analysis of variance, chi and t tests, and polytomous logistic regression.
Of 22 clinical parameters examined by univariate analysis of the tirilazad dataset, age, World Federation of Neurological Surgeons (WFNS) clinical grade, time from SAH to admission, history of hypertension or diabetes mellitus, aneurysm location, and admission diastolic and systolic blood pressure were correlated with the subarachnoid clot volume (P < 0.05). Polytomous logistic regression found that only age, WFNS grade, time to admission, admission systolic blood pressure, and history of hypertension were higher in patients with larger subarachnoid clots (P < 0.05). Analysis of 74 patients with quantitative subarachnoid clot volumes also found that age and WFNS grade were higher in patients with larger subarachnoid clots (P < 0.05). No aneurysm location or measurement of aneurysm size showed a statistically significant relationship to clot volume in either dataset.
SAH volume is correlated with clinical characteristics, including age, history of hypertension, admission systolic blood pressure, and WFNS grade. Anatomic aneurysm characteristics such as size and location do not reliably predict clot volume.
动脉瘤性蛛网膜下腔出血（SAH）后的脑血管痉挛与蛛网膜下腔血凝块的体积和位置有关。影响SAH体积的因素鲜有研究。
分析两组独立的数据。除了对74例SAH患者进行数字容积分析以确定入院计算机断层扫描的蛛网膜下腔血凝块体积的数据外，还分析了参与替拉扎德药物四项临床试验的3028例SAH患者的数据。在74例患者的较小样本中，在诊断性脑血管造影上测量动脉瘤的宽度、长度、颈部大小、纵横比和体积。通过单变量方法得出与血凝块体积相关因素问题的统计推断，包括方差分析、卡方检验和t检验以及多分类逻辑回归。
通过替拉扎德数据集的单变量分析检查的22个临床参数中，年龄、世界神经外科医师联合会（WFNS）临床分级、从SAH到入院的时间、高血压或糖尿病病史、动脉瘤位置以及入院时舒张压和收缩压与蛛网膜下腔血凝块体积相关（P<0.05）。多分类逻辑回归发现，只有年龄、WFNS分级、入院时间、入院收缩压和高血压病史在蛛网膜下腔血凝块较大的患者中更高（P<0.05）。对74例有定量蛛网膜下腔血凝块体积的患者进行分析也发现，蛛网膜下腔血凝块较大的患者年龄和WFNS分级更高（P<0.05）。在任何一个数据集中，动脉瘤位置或动脉瘤大小测量均未显示与血凝块体积有统计学显著关系。
SAH体积与临床特征相关，包括年龄、高血压病史、入院收缩压和WFNS分级。动脉瘤的解剖特征如大小和位置不能可靠地预测血凝块体积。
