急性可卡因使用对颅内动脉瘤性蛛网膜下腔出血的影响。

Impact of acute cocaine use on aneurysmal subarachnoid hemorrhage.

机构信息

Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.

出版信息

Stroke. 2013 Jul;44(7):1825-9. doi: 10.1161/STROKEAHA.111.000749. Epub 2013 May 7.

DOI:10.1161/STROKEAHA.111.000749

PMID:23652270

Abstract

BACKGROUND AND PURPOSE

Acute cocaine use has been temporally associated with aneurysmal subarachnoid hemorrhage (aSAH). This study analyzes the impact of cocaine use on patient presentation, complications, and outcomes.

METHODS

Data of patients admitted with aSAH between 1991 and 2009 were reviewed to determine impact of acute cocaine use (C). These patients were compared with aSAH patients without recent cocaine exposure (NC) in relation to their presentation, complications such as aneurysmal rerupture and delayed cerebral ischemia, and outcomes including hospital mortality and functional outcome.

RESULTS

Data of 1134 aSAH patients were reviewed; 142 patients (12.5%) had associated cocaine use. Cocaine users were more likely to be younger (mean age: C, 49±11; NC, 53±14; P<0.001). There were no differences in rates of poor-grade Hunt and Hess (4-5); (C, 21%; NC, 26%; P>0.05), associated intraventricular hemorrhage (C, 56%; NC, 51%; P>0.05), or hydrocephalus on admission Head CT (C, 49%; NC, 52%; P>0.05). Aneurysm rerupture incidence was higher among cocaine users (C, 7.7%; NC, 2.7%; P<0.05). The association of cocaine use with higher risk of delayed cerebral ischemia (C, 22%; NC, 16%; P<0.05) was not significant after correcting for other factors. Cocaine users were less likely to survive hospitalization compared with nonusers (mortality: C, 26%; NC, 17%; P<0.05); the adjusted odds of hospital mortality were 2.9 times higher among cocaine users (P<0.001). There were no differences in functional outcomes between the 2 groups.

CONCLUSIONS

Acute cocaine use was associated with a higher risk of aneurysm rerupture and hospital mortality after aSAH.

摘要

背景与目的

急性可卡因使用与蛛网膜下腔出血（aSAH）之间存在时间关联。本研究分析了可卡因使用对患者表现、并发症和结局的影响。

方法

回顾了 1991 年至 2009 年间因 aSAH 住院的患者数据，以确定急性可卡因使用（C）的影响。将这些患者与近期无可卡因暴露的 aSAH 患者（NC）进行比较，比较内容包括他们的表现、并发症（如动脉瘤再破裂和迟发性脑缺血）和结局（包括住院死亡率和功能结局）。

结果

共回顾了 1134 例 aSAH 患者的数据，其中 142 例（12.5%）有相关可卡因使用。可卡因使用者更年轻（平均年龄：C，49±11；NC，53±14；P<0.001）。不良 Hunt 和 Hess 分级（4-5）的发生率无差异（C，21%；NC，26%；P>0.05），合并脑室出血的发生率（C，56%；NC，51%；P>0.05）或入院头部 CT 显示脑积水的发生率（C，49%；NC，52%；P>0.05）。可卡因使用者动脉瘤再破裂的发生率更高（C，7.7%；NC，2.7%；P<0.05）。在校正其他因素后，可卡因使用与迟发性脑缺血风险增加（C，22%；NC，16%；P<0.05）之间的关联并不显著。与非使用者相比，可卡因使用者住院期间的存活率较低（死亡率：C，26%；NC，17%；P<0.05）；可卡因使用者的住院死亡率调整后比值比为 2.9 倍（P<0.001）。两组之间的功能结局无差异。