Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA.
Department of Neurology and Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2014 Jul-Aug;82(1-2):e235-41. doi: 10.1016/j.wneu.2014.02.030. Epub 2014 Feb 20.
To determine national trends for patients with subarachnoid hemorrhage (SAH) and pulmonary complications including acute respiratory distress syndrome (ARDS).
The Nationwide Inpatient Sample database was used to sample 193,209 admissions for SAH with and without ARDS during the period 1993-2008 using International Classification of Diseases, Ninth Revision, Clinical Modification coding. A multivariate stepwise regression analysis was performed.
The incidence of ARDS in patients with SAH increased from 35.51% in 1993 to 37.60% in 2008. However, the overall mortality in patients with SAH and in patients with SAH and ARDS decreased in the same period, from 42.30% to 31.99% and from 75.13% to 60.76%, respectively. Multivariate analysis showed that the predictors of developing ARDS in patients with SAH include older age; larger hospital size; and comorbidities such as epilepsy, cardiac arrest, sepsis, congestive heart failure, hypertension, chronic obstructive pulmonary disease, hematologic dysfunction, renal dysfunction, and neurologic dysfunction. Predictors of mortality in patients with SAH include age and hospital complications, such as coronary artery disease, ARDS, cancer, hematologic dysfunction, and renal dysfunction.
Patients with SAH are at increased risk of developing ARDS. The identification of certain risk factors may alert and aid practitioners in preventing worsening disease.
确定蛛网膜下腔出血（SAH）患者和包括急性呼吸窘迫综合征（ARDS）在内的肺部并发症的全国趋势。
利用 1993 年至 2008 年期间全国住院患者样本数据库，使用国际疾病分类，第九版，临床修正编码，对伴有和不伴有 ARDS 的 193209 例 SAH 入院患者进行抽样。采用多元逐步回归分析。
SAH 患者中 ARDS 的发生率从 1993 年的 35.51%增加到 2008 年的 37.60%。然而，同期 SAH 患者和 SAH 合并 ARDS 患者的总体死亡率均有所下降，分别从 42.30%降至 31.99%和从 75.13%降至 60.76%。多变量分析显示，SAH 患者发生 ARDS 的预测因素包括年龄较大；医院规模较大；癫痫、心搏骤停、败血症、充血性心力衰竭、高血压、慢性阻塞性肺疾病、血液功能障碍、肾功能障碍和神经功能障碍等合并症。SAH 患者死亡的预测因素包括年龄和医院并发症，如冠状动脉疾病、ARDS、癌症、血液功能障碍和肾功能障碍。
SAH 患者发生 ARDS 的风险增加。确定某些危险因素可能有助于医生及早发现并预防疾病恶化。
