Tykocki Tomasz, Czyż Marcin, Machaj Małgorzata, Szydlarska Dorota, Kostkiewicz Bogusław
a Department of Neurosurgery , Institute of Psychiatry and Neurology in Warsaw , Warsaw , Poland.
b The Centre for Spinal Studies and Surgery , Queens Medical Centre , Nottingham , UK.
Br J Neurosurg. 2017 Aug;31(4):430-433. doi: 10.1080/02688697.2017.1319906. Epub 2017 Apr 24.
The timing and modality of intervention in the treatment of poor-grade aneurysmal subarachnoid haemorrhage (aSAH) has not been defined. The purpose of the study is to analyse whether early treatment and type of intervention influence the clinical outcomes of poor-grade aSAH patients.
Patients with poor-grade aSAH were retrieved. Demographics, Fisher grade, radiological characteristics and clinical outcomes were recorded. Outcomes were compared using the modified Rankin Scale (mRS), for groups treated early within 24 hours of aSAH or later and by clipping or endovascular therapy. Multivariate multiple regression model and logistic regression were used to assess factors affecting outcomes at discharge in mRS and length of stay.
The study was conducted on 79 patients. 47 (59%) were treated by clipping, 38 (48%) received intervention within 24 hours of aSAH. Patients treated <24h had significantly lower mortality (n = 5; 13% vs. n = 14; 37%; p < .023), higher rate of 0-3 mRS (n = 22;58% vs. n = 9; 22%; p < .039) and were younger (49.5 ± 6.1 vs. 65.8 ± 7.4 years; p < .038). There were no significant differences in mRS between clipping and endovascular therapy. Predictors of length of stay were ICH, MLS, endovascular therapy, location in posterior circulation, Fisher grade and time to intervention <24h. Early intervention, <24h significantly influenced the favourable results in mRS (0-3); (OR 4,14; Cl95% 3.82-4.35). Posterior circulation aneurysms, midline shift and intracerebral hematoma were correlated with poor outcomes.
Early treatment, within 24 h, of poor-grade aSAH confirmed better clinical outcome compared to later aneurysm securement. There was no significant difference between clipping and endovascular treatment.
未破裂动脉瘤性蛛网膜下腔出血（aSAH）治疗的干预时机和方式尚未明确。本研究旨在分析早期治疗及干预类型是否会影响aSAH患者的临床结局。
检索aSAH患者。记录人口统计学资料、Fisher分级、影像学特征及临床结局。采用改良Rankin量表（mRS）对aSAH发病24小时内或之后接受治疗的患者组以及接受夹闭或血管内治疗的患者组的结局进行比较。使用多变量多元回归模型和逻辑回归评估影响出院时mRS结局及住院时间的因素。
本研究共纳入79例患者。47例（59%）接受夹闭治疗，38例（48%）在aSAH发病24小时内接受干预。发病<24小时接受治疗的患者死亡率显著更低（n = 5；13% 对比 n = 14；37%；p < 0.023），0 - 3级mRS比例更高（n = 22；58% 对比 n = 9；22%；p < 0.039），且更年轻（49.5 ± 6.1岁对比65.8 ± 7.4岁；p < 0.038）。夹闭治疗和血管内治疗在mRS方面无显著差异。住院时间的预测因素包括脑出血、最大层流速度、血管内治疗、后循环位置、Fisher分级及干预时间<24小时。早期干预（<24小时）对mRS（0 - 3级）的良好结局有显著影响；（比值比4.14；95%置信区间3.82 - 4.35）。后循环动脉瘤、中线移位和脑内血肿与不良结局相关。
与延迟动脉瘤夹闭相比，aSAH患者在24小时内进行早期治疗可获得更好的临床结局。夹闭治疗和血管内治疗之间无显著差异。
