Sarabia R, Lagares A, Fernández-Alén J A, Arikan F, Vilalta J, Ibáñez J, Maillo A, Gabarros A, Domínguez J, Horcajadas A, Ballenilla F, Rodríguez-Boto G, Llacer J L, Arrese I, de la Lama A, Santamarta D, Delgado P, Muñoz M F
Hospital Clínico Universitario Valladolid, Madrid, Spain.
Neurocirugia (Astur). 2010 Dec;21(6):441-51. doi: 10.1016/s1130-1473(10)70094-4.
BACKGROUND. The Spanish neurosurgical society created a multicentre data base on spontaneous SAH to analyze the real problematic of this disease in our country. This paper focuses on the group of patients with idiopathic SAH (ISAH). METHODS. 16 participant hospitals collect their spontaneous SAH cases in a common data base shared in the internet through a secured web page, considering clinical, radiological, evolution and outcome variables. The 220 ISAH cases collected from November 2004 to November 2007 were statistically analyzed as a whole and divided into 3 subgroups depending on the CT blood pattern (aneurysmal, perimesencephalic, or normal). RESULTS. The 220 ISAH patients constitute 19% of all 1149 spontaneous SAH collected in the study period. In 46,8% of ISAH the blood CT pattern was aneurysmal, which was related to older age, worse clinical condition, higher Fisher grade, more hydrocephalus and worse outcome, compared to perimesencephalic (42.7%) or normal CT (10.4%) pattern. Once surpassed the acute phase, outcome of ISAH patients is similarly good in all 3 ISAH subgroups, significantly better as a whole compared to aneurysmal SAH patients. The only variable related to outcome in ISAH after a logistic regression analysis was the admission clinical grade. CONCLUSIONS. ISAH percentage of spontaneous SAH is diminishing in Spain. Classification of ISAH cases depending on the blood CT pattern is important to differentiate higher risk groups although complications are not negligible in any of the ISAH subgroups. Neurological status on admission is the single most valuable prognostic factor for outcome in ISAH patients.
背景。西班牙神经外科学会创建了一个关于自发性蛛网膜下腔出血（SAH）的多中心数据库，以分析我国这种疾病的实际问题。本文聚焦于特发性蛛网膜下腔出血（ISAH）患者群体。方法。16家参与研究的医院通过一个安全的网页，将其自发性SAH病例收集到一个互联网共享的通用数据库中，其中考虑了临床、放射学、病情演变及预后等变量。对2004年11月至2007年11月收集的220例ISAH病例进行整体统计分析，并根据CT血液模式（动脉瘤性、中脑周围性或正常）分为3个亚组。结果。220例ISAH患者占研究期间收集的1149例自发性SAH病例的19%。在46.8%的ISAH病例中，CT血液模式为动脉瘤性，与中脑周围性（42.7%）或正常CT模式（10.4%）相比，这与年龄较大、临床状况较差、Fisher分级较高、脑积水较多及预后较差有关。一旦度过急性期，所有3个ISAH亚组的ISAH患者预后同样良好，总体上明显优于动脉瘤性SAH患者。经逻辑回归分析，ISAH中与预后相关的唯一变量是入院时的临床分级。结论。在西班牙，ISAH在自发性SAH中的比例正在下降。根据CT血液模式对ISAH病例进行分类对于区分高风险组很重要，尽管在任何一个ISAH亚组中并发症都不可忽视。入院时的神经状态是ISAH患者预后的唯一最有价值的预后因素。
