Rahmanian Abdolkarim, Jamali Mohammad, Bagheri Lankarani Kamran, Ghahramani Sulmaz
Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
PLoS One. 2017 Nov 30;12(11):e0189005. doi: 10.1371/journal.pone.0189005. eCollection 2017.
Subarachnoid haemorrhage (SAH), caused by the rupture of intracranial aneurysms, is a devastating event with high rates of morbidity and mortality. Aneurysmal subarachnoid haemorrhage (aSAH) plays a critical role in the potential loss of life as its sufferers are usually of a young age. We aimed to investigate the incidence of aSAH along with the patients' characteristics over five consecutive years in Fars, a large province located in Southern Iran.
In this prospective study, anonymous data of all patients diagnosed with aSAH in Fars province were collected after patient admission and surgery. Data from the last national census in 2011 were used to calculate the incidence. The data were analysed using SPSS software version 18 using independent sample t test, chi square test and ANOVA. The significance level was set at 0.05.
The number of aSAH cases identified in Fars, Iran, each year varied between 78 (2011) and 98 (2015) for a total of 421 aSAH cases within the 5-year study period. The annual aSAH incidence estimates showed no differences and were 1.65 [95% confidence interval (CI): 1.58-1.72], 1.70 (95%CI: 1.68-1.72), 1.71 (95%CI: 1.63-1.78), 1.82 (95%CI: 1.74-1.9), and 2.05 (95%CI: 1.97-2.13) per 100,000 persons, respectively, for the five consecutive years from 21 March 2011 to 20 March 2016. Hypertension was the most common risk factor, and was found in 198 (48%) aSAH patients. Ninety-four (22.5%) patients had moderate hydrocephalus on admission. Middle cerebral artery and anterior communicating artery were the most common sites of aneurysms. On admission, 351 (83%) patients had a Glasgow Coma Scale score >7, 197 (47%) presented with Hunt and Hess score of 1, and 365 (87%) had a Fisher score of ≤3. Multiple aneurysms were found in 59 (14%) of the 421 cases and the most common risk factors in multiple aneurysms were hypertension in 30 (51%) and smoking in 26 (44%) cases. Survival data were available only on patients diagnosed in year 2015, and the six-month survival rate was 89.8%.
This study revealed that although the incidence of aSAH remained stable, the survival of aSAH patients who reached the hospital alive and were operated on, improved in Shiraz (the six-month survival rate was 89.8% in year 2015). The incidence and survival study on aSAH in other geographic areas of Iran as a multi-centre study is recommended. There is a need to inform primary healthcare workers regarding the possibility of aSAH in a patient with signs of the sentinel headache.
由颅内动脉瘤破裂引起的蛛网膜下腔出血（SAH）是一种具有高发病率和死亡率的灾难性事件。动脉瘤性蛛网膜下腔出血（aSAH）在潜在的生命损失中起关键作用，因为其患者通常较为年轻。我们旨在调查伊朗南部一个大省法尔斯连续五年内aSAH的发病率及其患者特征。
在这项前瞻性研究中，法尔斯省所有被诊断为aSAH的患者在入院和手术后收集匿名数据。使用2011年上次全国人口普查的数据来计算发病率。数据使用SPSS软件18版，通过独立样本t检验、卡方检验和方差分析进行分析。显著性水平设定为0.05。
在伊朗法尔斯，每年确诊的aSAH病例数在78例（2011年）至98例（2015年）之间变化，在5年研究期内共有421例aSAH病例。年度aSAH发病率估计无差异，从2011年3月21日至2016年3月20日的连续五年中，每10万人中的发病率分别为1.65[95%置信区间（CI）：1.58 - 1.72]、1.70（95%CI：1.68 - 1.72）、1.71（95%CI：1.63 - 1.78）、1.82（95%CI：1.74 - 1.9）和2.05（95%CI：1.97 - 2.13）。高血压是最常见的危险因素，在198例（48%）aSAH患者中发现。94例（22.5%）患者入院时患有中度脑积水。大脑中动脉和前交通动脉是最常见的动脉瘤部位。入院时，351例（83%）患者格拉斯哥昏迷量表评分>7，197例（47%）呈现亨特和赫斯评分为1，365例（87%）费舍尔评分为≤3。421例病例中有59例（14%）发现多发动脉瘤，多发动脉瘤中最常见的危险因素是高血压30例（51%）和吸烟26例（44%）。仅获得了2015年诊断患者的生存数据，六个月生存率为89.8%。
本研究表明，尽管aSAH的发病率保持稳定，但在设拉子，存活并接受手术的aSAH患者生存率有所提高（2015年六个月生存率为89.8%）。建议在伊朗其他地理区域开展多中心研究，对aSAH进行发病率和生存情况研究。有必要告知基层医护人员，出现哨兵头痛症状患者存在aSAH的可能性。
