Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka, Japan.
J Neurointerv Surg. 2011 Dec 1;3(4):344-7. doi: 10.1136/jnis.2010.004077. Epub 2011 Mar 1.
The purpose of this study was to clarify the clinical predictors of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH).
102 patients with ruptured cerebral aneurysms were treated (77 by clipping and 25 by coiling). 40 patients were male and 62 were female. Median age was 59 years (range 31-88). The modified Rankin Scale was used to assess functional outcomes 3 months after treatment or at discharge. The associations between potential clinical risk factors and DCI after SAH were assessed using the χ(2) test.
52 patients (51.0%) had a good outcome and 13 patients (12.7%) died despite treatment. DCI was observed in 26 patients and hydrocephalus was observed in 37 patients. There were marginal differences in clinical outcomes between the treatment groups (p=0.053), mainly because functional outcomes were significantly superior in the coiling group (p=0.04) in patients with severe SAH. DCI was seen less frequently in the coiling group than in the clipping group (4.0% vs 32.4%, p=0.001). The presence of hydrocephalus was significantly associated with the occurrence of DCI (p<0.001). Multivariate logistic regression analysis also showed that the treatment modality and the presence of hydrocephalus were independent risk factors for DCI.
DCI was less frequently observed in the coiling group, and clinical outcomes were also superior in the coiling group, especially for patients with severe SAH. The results showed a significant correlation between DCI and hydrocephalus.
本研究旨在阐明蛛网膜下腔出血（SAH）后迟发性脑缺血（DCI）的临床预测因素。
对 102 例破裂脑动脉瘤患者进行治疗（夹闭 77 例，血管内介入栓塞 25 例）。其中男 40 例，女 62 例。中位年龄为 59 岁（范围 31-88 岁）。采用改良 Rankin 量表评估治疗后 3 个月或出院时的功能结局。采用 χ(2)检验评估潜在临床危险因素与 SAH 后 DCI 的关系。
52 例（51.0%）患者预后良好，13 例（12.7%）患者尽管治疗仍死亡。26 例患者出现 DCI，37 例患者出现脑积水。治疗组间临床结局存在差异（p=0.053），主要是因为在严重 SAH 患者中，血管内介入栓塞组的功能结局明显优于夹闭组（p=0.04）。血管内介入栓塞组 DCI 的发生率明显低于夹闭组（4.0%比 32.4%，p=0.001）。脑积水的存在与 DCI 的发生显著相关（p<0.001）。多变量 logistic 回归分析也显示，治疗方式和脑积水的存在是 DCI 的独立危险因素。
血管内介入栓塞组 DCI 的发生率较低，血管内介入栓塞组的临床结局也较好，尤其是在严重 SAH 患者中。结果表明 DCI 与脑积水之间存在显著相关性。
