Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
J Neurol. 2013 Mar;260(3):820-31. doi: 10.1007/s00415-012-6710-4. Epub 2012 Oct 25.
Post-procedure hemodynamic management for aneurysmal subarachnoid hemorrhage is controversial because of the paucity of studied patients. Using a Japanese administrative database, we tested whether increased albumin, catecholamine, and volumes of fluid administered between the procedure and the 4th post-procedure day would be associated with outcomes of mortality, consciousness deterioration at discharge and re-intubation between the 5th and 14th post-procedure days. Across 550 hospitals, 5,400 patients were identified who received clipping, wrapping and endovascular coiling within 48 h after admission in 2010. Patient characteristics and the administration of albumin, catecholamine, and volume of fluid normalized by body weight were analyzed among the groups and categorized according to the presence of albumin and catecholamine administered between the procedure and the 4th post-procedure day. The association of early hemodynamic management with outcomes was measured using logistic regression models, through controlling for the preference of early administration of albumin and catecholamine. For the patients, 9.3 % received albumin only, 14.4 % catecholamine only, and 4.9 % both between the procedure and the 4th post-procedure day, while 16.5 % received albumin or catecholamine on other days. Variation in albumin and catecholamine administration was observed. Higher normalized fluid volume, commenced before the 4th post-procedure day, was associated with increased mortality and re-intubation (although with decreased complications), and vice versa between the 4th and 14th post-procedure days. Catecholamine administration was associated with worsened outcomes. Hypervolemic and hypertensive therapies commenced before the 4th post-procedure day require further research to determine whether their associations with outcomes in this administrative data base are causal or not.
术后处理对颅内动脉瘤性蛛网膜下腔出血患者的血流动力学管理具有争议性，这是因为经过研究的患者数量较少。本研究使用日本行政数据库，旨在检验手术至术后第 4 天期间白蛋白、儿茶酚胺和液体输入量的增加是否与死亡率、出院时意识恶化和术后第 5-14 天期间再插管有关。研究纳入了 2010 年接受夹闭、包裹和血管内介入治疗且在发病后 48 小时内入院的 550 家医院的 5400 例患者。分析各组患者的白蛋白、儿茶酚胺和体重标准化的液体输入量的特点，并根据手术至术后第 4 天之间是否给予白蛋白和儿茶酚胺进行分类。通过控制早期给予白蛋白和儿茶酚胺的倾向，使用逻辑回归模型来衡量早期血流动力学管理与结局的相关性。对于患者而言，9.3%仅在手术至术后第 4 天之间接受白蛋白治疗，14.4%仅接受儿茶酚胺治疗，4.9%同时接受白蛋白和儿茶酚胺治疗，16.5%在其他时间接受白蛋白或儿茶酚胺治疗。白蛋白和儿茶酚胺的使用存在差异。在术后第 4 天之前开始使用更高的标准化液体量与死亡率和再插管增加有关（尽管并发症减少），而在术后第 4-14 天之间则相反。儿茶酚胺的使用与较差的结局相关。在术后第 4 天之前开始的高血容量和高血压治疗需要进一步研究，以确定在这个行政数据库中它们与结局的关联是否具有因果关系。
