Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
J Trauma Acute Care Surg. 2012 Jul;73(1):131-6. doi: 10.1097/TA.0b013e31824aff74.
To clarify the clinical role of traumatic subarachnoid hemorrhage (tSAH), stratified analysis with grouping of tSAH was performed. Their blood flow changes and correlations with outcome were assayed.
One hundred seventeen tSAH patients were classified into several groups according to their initial computerized tomography scans. Group I included patients with tSAH only in the posterior interhemispheric fissure, whereas Group II contained patients with tSAH located elsewhere. Group II was further subdivided into IIa, little SAH; IIb, extensive SAH; IIc, little SAH with intraventricular hemorrhage (IVH); and IId, extensive SAH with IVH. The cerebral blood flow velocity was monitored using transcranial Doppler sonography (TCD).
Both age and initial coma scale were independent predictors of poor outcome. The poor outcome rates in various subgroups of tSAH increased stepwise from group I to group IId (I, 7.4%; IIa, 18.4%; IIb, 33.3%; IIc, 62.5%; and IId, 90.9%) (p = 0.0010). Stratified analyses revealed that patients with extensive tSAH (group IIb + IId) were more likely to have unfavorable outcomes (47.7%) than patients with little tSAH (group IIa + IIc) (26.1%) (p = 0.0185); patients with IVH (group IIc + IId) also displayed a higher incidence (78.9%) of poor outcomes than patients without IVH (group IIa + IIb) (25.4%) (p = 0.0030). TCD study demonstrated that patients with extensive tSAH (group IIb + IId) were more likely to have the vasospasm based on TCD criteria than did patients in group I and group IIa + IIc (37.5% vs. 5.9% and 7.7%, p = 0.0105). Notably, there was a tendency of worse outcome in patients with vasospasm on the basis of TCD-derived criteria than those without, with the unfavorable outcome rates being 47.4% and 24.7% (p = 0.0799).
Age, initial coma scale, extensive tSAH, and IVH are independent predictors of poor outcome in the cohort of tSAH patients. Statistically, patients with extensive tSAH are significantly more likely to have vasospasm.
为了阐明创伤性蛛网膜下腔出血（tSAH）的临床作用，对 tSAH 进行了分层分析，并对其分组进行了分析。检测了它们的血流变化及其与结果的相关性。
根据初始计算机断层扫描，将 117 例 tSAH 患者分为几组。第 I 组患者仅蛛网膜下腔出血位于后纵裂，而第 II 组患者蛛网膜下腔出血位于其他部位。第 II 组进一步细分为 IIa，少量 SAH；IIb，广泛的 SAH；IIc，少量伴有脑室出血（IVH）的 SAH；和 IId，广泛的伴有 IVH 的 SAH。使用经颅多普勒超声（TCD）监测脑血流速度。
年龄和初始昏迷量表是不良预后的独立预测因子。tSAH 各亚组的不良预后率从第 I 组到第 IId 组呈阶梯式上升（I 组为 7.4%；IIa 组为 18.4%；IIb 组为 33.3%；IIc 组为 62.5%；IId 组为 90.9%）（p=0.0010）。分层分析显示，广泛的 tSAH（IIb+IId）患者比少量 tSAH（IIa+IIc）患者（47.7%比 26.1%）更有可能出现不良预后（p=0.0185）；伴有 IVH（IIc+IId）的患者（78.9%）比不伴有 IVH（IIa+IIb）的患者（25.4%）更有可能出现不良预后（p=0.0030）。TCD 研究表明，与第 I 组和第 IIa+IIc 组相比，广泛的 tSAH（IIb+IId）患者更有可能根据 TCD 标准发生血管痉挛（37.5%比 5.9%和 7.7%，p=0.0105）。值得注意的是，根据 TCD 衍生标准，伴有血管痉挛的患者预后较差的趋势比不伴有血管痉挛的患者更明显，不良预后率分别为 47.4%和 24.7%（p=0.0799）。
年龄、初始昏迷量表、广泛的 tSAH 和 IVH 是 tSAH 患者预后不良的独立预测因子。从统计学上看，广泛的 tSAH 患者发生血管痉挛的可能性显著增加。
