Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Neurocrit Care. 2013 Dec;19(3):320-8. doi: 10.1007/s12028-013-9890-6.
Brain oxygen (PbtO2) monitoring can help guide care of poor-grade aneurysmal subarachnoid hemorrhage (aSAH) patients. The relationship between PbtO2-directed therapy and long-term outcome is unclear. We hypothesized that responsiveness to PbtO2-directed interventions is associated with outcome.
Seventy-six aSAH patients who underwent PbtO2 monitoring were included. Long-term outcome [Glasgow Outcome Score-Extended (GOS-E) and modified Rankin Scale (mRS)] was ascertained using the social security death database and structured telephone interviews. Univariate and multivariate regression were used to identify variables that correlated with outcome.
Data from 64 patients were analyzed (12 were lost to follow-up). There were 530 episodes of compromised PbtO2 (<20 mmHg) during a total of 7,174 h of monitor time treated with 1,052 interventions. Forty-two patients (66 %) survived to discharge. Median follow-up was 8.5 months (range 0.1-87). At most recent follow-up 35 (55 %) patients were alive, and 28 (44 %) had a favorable outcome (mRS ≤3). In multivariate ordinal regression analysis, only age and response to PbtO2-directed intervention correlated significantly with outcome. Increased age was associated with worse outcome (coeff. 0.8, 95 % CI 0.3-1.3, p = 0.003), and response to PbtO2-directed intervention was associated with improved outcome (coeff. -2.12, 95 % CI -4.0 to -0.26, p = 0.03). Patients with favorable outcomes had a 70 % mean rate of response to PbtO2-directed interventions whereas patients with poor outcomes had a 45 % response rate (p = 0.005).
Response to PbtO2-directed intervention is associated with improved long-term functional outcome in aSAH patients.
脑氧（PbtO2）监测有助于指导治疗低分级动脉瘤性蛛网膜下腔出血（aSAH）患者。但 PbtO2 指导治疗与长期预后之间的关系尚不清楚。我们假设对 PbtO2 指导干预的反应性与预后相关。
纳入 76 例行 PbtO2 监测的 aSAH 患者。通过社会安全死亡数据库和结构化电话访谈确定长期预后（格拉斯哥预后评分扩展版（GOS-E）和改良 Rankin 量表（mRS））。采用单变量和多变量回归分析确定与预后相关的变量。
分析了 64 例患者的数据（12 例失访）。在总共 7174 小时的监测时间内，有 530 次 PbtO2 （<20mmHg） 监测结果提示脑氧合不足，共进行了 1052 次干预。42 例患者（66%）存活至出院。中位随访时间为 8.5 个月（范围 0.1-87）。在最近的随访中，35 例（55%）患者存活，28 例（44%）预后良好（mRS ≤3）。在多变量有序回归分析中，只有年龄和对 PbtO2 指导干预的反应与结局显著相关。年龄增加与预后不良相关（系数 0.8，95%CI 0.3-1.3，p=0.003），对 PbtO2 指导干预的反应与预后改善相关（系数-2.12，95%CI-4.0 至-0.26，p=0.03）。预后良好的患者对 PbtO2 指导干预的平均反应率为 70%，而预后不良的患者的反应率为 45%（p=0.005）。
对 PbtO2 指导干预的反应与 aSAH 患者的长期功能预后改善相关。
