定义高级别动脉瘤性蛛网膜下腔出血后的生存情况。

Defining survivorship after high-grade aneurysmal subarachnoid hemorrhage.

作者信息

Quigley Matthew R, Salary Montell

机构信息

Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA 15212, USA.

出版信息

Surg Neurol. 2008 Mar;69(3):261-5; discussion 265. doi: 10.1016/j.surneu.2007.02.013. Epub 2008 Jan 24.

DOI:10.1016/j.surneu.2007.02.013

PMID:18221774

Abstract

BACKGROUND

Outcome after high-grade aneurysmal SAH is poor. Various treatment paradigms have been advanced to improve treatment outcome and preserve resources, but none have addressed the potential salvageable life lost.

METHODS

We retrospectively reviewed all patients with high-grade (H&H score, 4-5) aneurysmal SAH admitted to our institution from January 1998 to June 2002, all aggressively managed, to determine what clinical/radiographic criteria predicted favorable survival.

RESULTS

There were 50 patients analyzed. All underwent emergency ventriculostomies or clot evacuations. Twenty-three patients (46%) improved and 7 (14%) worsened; 41 survived to receive definitive therapy. Twenty-one patients (42%) overall achieved a favorable outcome (GOS, 4-5). In the multivariate analysis (stepwise logistic regression), the postresuscitation GCSm alone predicted outcome (P= .004) with 70% cases correctly identified, whereas age, location of aneurysm (anterior circulation or not), presence of intraventricular hemorrhage, time to definitive intervention, clot on computerized tomography, type of therapy used (coil vs clip), pupillary abnormalities, and preresuscitation GCSm did not. Because the sole predictive parameter is obtained postresuscitation, no clinical or radiographic factor on presentation appears valid to determine eligibility for definitive care.

CONCLUSION

Overall treatment outcome of our series is comparable with those of other articles. Our experience, as well as review of literature, does not support the existence of a validated "triage" schema to selectively treat patients with high-grade subarachnoid hemorrhage, implying that all such patients should be managed aggressively.

摘要

背景

高级别动脉瘤性蛛网膜下腔出血（SAH）的预后较差。已经提出了各种治疗模式以改善治疗效果并节省资源，但均未解决潜在的可挽救生命损失问题。

方法

我们回顾性分析了1998年1月至2002年6月间入住我院的所有高级别（H&H评分，4 - 5分）动脉瘤性SAH患者，所有患者均接受积极治疗，以确定哪些临床/影像学标准可预测良好生存。

结果

共分析了50例患者。所有患者均接受了急诊脑室造瘘术或血块清除术。23例患者（46%）病情改善，7例（14%）病情恶化；41例患者存活至接受确定性治疗。总体上，21例患者（42%）获得了良好预后（格拉斯哥预后评分，4 - 5分）。在多因素分析（逐步逻辑回归）中，复苏后格拉斯哥昏迷量表运动评分（GCSm）单独可预测预后（P = 0.004），正确识别率为70%，而年龄、动脉瘤位置（是否为前循环）、脑室内出血的存在、确定性干预时间、计算机断层扫描上的血块、所用治疗类型（弹簧圈栓塞与夹闭）、瞳孔异常以及复苏前GCSm则不能。由于唯一的预测参数是在复苏后获得的，因此在就诊时没有临床或影像学因素似乎可有效确定是否适合接受确定性治疗。