Oheda Motoki, Inamasu Joji, Moriya Shigeta, Kumai Tadashi, Kawazoe Yushi, Nakae Shunsuke, Kato Yoko, Hirose Yuichi
Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake 470-1192, Japan.
Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake 470-1192, Japan.
J Clin Neurosci. 2015 Aug;22(8):1338-42. doi: 10.1016/j.jocn.2015.02.024. Epub 2015 Jun 13.
The objective of this study was to report the frequency and clinical characteristics of early rebleeding in subarachnoid haemorrhage (SAH) patients who underwent intensive blood pressure (BP) management. Patients with aneurysmal SAH frequently present to the emergency department (ED) with elevated BP. Intensive BP management has been recommended to lower the risk of early rebleeding. However, few studies have reported the frequency of early rebleeding in SAH patients undergoing BP management. In our institution, SAH patients with systolic BP (SBP)>140 mmHg received continuous intravenous nicardipine to maintain their SBP within 120±20 mmHg after diagnosis. An attempt to implement intensive BP management was made on 309 consecutive SAH patients who presented to our ED within 48 hours of SAH onset. Overall, 24 (7.8%) of the 309 patients sustained early rebleeding. Fifteen patients sustained early rebleeding before the implementation of BP management, and the other nine sustained early rebleeding after the implementation of BP management. Therefore, the frequency of early rebleeding under BP management was 3.1% (9/294). When the 309 patients were dichotomised using ED SBP of 140 mmHg as a cut off (SBP>140 mmHg; n=239 versus SBP⩽140 mmHg; n=70), the latter counter-intuitively exhibited a significantly higher frequency of early rebleeding (5.9% versus 14.2%; p=0.04). This relatively low frequency of early rebleeding under BP management may be acceptable. However, early rebleeding is not eradicated even with strict BP control as factors other than elevated BP are involved. ED SBP within the target range (SBP⩽140 mmHg) does not negate the risk of early rebleeding. Other treatment options that reduce the risk should also be explored.
本研究的目的是报告接受强化血压管理的蛛网膜下腔出血（SAH）患者早期再出血的发生率及临床特征。动脉瘤性SAH患者常因血压升高而就诊于急诊科（ED）。推荐进行强化血压管理以降低早期再出血风险。然而，鲜有研究报道接受血压管理的SAH患者早期再出血的发生率。在我们机构，收缩压（SBP）>140 mmHg的SAH患者在诊断后接受持续静脉输注尼卡地平，以使SBP维持在120±20 mmHg。对309例在SAH发病后48小时内就诊于我们急诊科的连续SAH患者尝试进行强化血压管理。总体而言，309例患者中有24例（7.8%）发生早期再出血。15例患者在实施血压管理前发生早期再出血，另外9例在实施血压管理后发生早期再出血。因此，血压管理下早期再出血的发生率为3.1%（9/294）。当以140 mmHg的ED SBP作为切点将309例患者分为两组（SBP>140 mmHg；n = 239与SBP≤140 mmHg；n = 70）时，与直觉相反，后者早期再出血的发生率显著更高（5.9%对14.2%；p = 0.04）。血压管理下这种相对较低的早期再出血发生率可能是可以接受的。然而，即使严格控制血压，早期再出血也无法根除，因为除血压升高外还涉及其他因素。目标范围内的ED SBP（SBP≤140 mmHg）并不能消除早期再出血的风险。还应探索其他降低风险的治疗选择。
