Nemoto Masaaki, Masuda Hiroyuki, Sakaeyama Yuki, Okonogi Sinichi, Node Yasuhiro, Ueda Keita, Ando Shunpei, Kondo Kosuke, Harada Naoyuki, Sugo Nobuo
Department of Neurosurgery(Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan.
Department of Neurosurgery(Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan.
J Stroke Cerebrovasc Dis. 2018 May;27(5):1160-1166. doi: 10.1016/j.jstrokecerebrovasdis.2017.11.034. Epub 2017 Dec 25.
Subarachnoid hemorrhage (SAH) with an intracerebral hematoma (ICH) shows an unfavorable prognosis. In the present study, we examined the characteristics of SAH with ICH and its prognosis.
Subjects comprised 218 patients with SAH who underwent surgery between January 2007 and December 2015. We compared age, sex, the location of the aneurysm, treatment procedures, medical history (hypertension, diabetes, and heart disease), the Glasgow Coma Scale (GCS) score on admission, rerupture rate, hydrocephalus, the diameter of the aneurysm, cerebral vasospasm, perioperative cardiopulmonary complications, and the Glasgow Outcome Scale (GOS) score after 2 months between patients with SAH with and without ICH. The interval from the onset of SAH until surgery, the location of ICH, and hematoma volume were investigated as prognostic factors for SAH with ICH.
Among all subjects, 82 had SAH with ICH. GCS scores on admission were poorer in patients with SAH with ICH than in those without ICH (P < .001), and middle cerebral artery aneurysms were more likely to form hematomas (P < .001). GOS scores after 2 months were also poorer in patients with SAH with ICH (P < .01). The size of aneurysms was larger in the 82 patients with SAH with ICH than in those without ICH (P < .001), and the rerupture rate was higher (P < .001). The unfavorable prognosis of patients with SAH with ICH was associated with age and GCS score on admission.
A young age and a favorable GCS score on admission may be associated with a favorable prognosis for patients with SAH with ICH, and SAH with ICH may easily rerupture.
伴有脑内血肿（ICH）的蛛网膜下腔出血（SAH）预后不佳。在本研究中，我们研究了伴有ICH的SAH的特征及其预后。
研究对象为2007年1月至2015年12月期间接受手术的218例SAH患者。我们比较了伴有和不伴有ICH的SAH患者的年龄、性别、动脉瘤位置、治疗方法、病史（高血压、糖尿病和心脏病）、入院时的格拉斯哥昏迷量表（GCS）评分、再破裂率、脑积水、动脉瘤直径、脑血管痉挛、围手术期心肺并发症以及2个月后的格拉斯哥预后量表（GOS）评分。研究了从SAH发作到手术的间隔时间、ICH的位置和血肿体积作为伴有ICH的SAH的预后因素。
在所有研究对象中，82例为伴有ICH的SAH。伴有ICH的SAH患者入院时的GCS评分比不伴有ICH的患者差（P＜0.001），大脑中动脉动脉瘤更容易形成血肿（P＜0.001）。伴有ICH的SAH患者2个月后的GOS评分也较差（P＜0.01）。82例伴有ICH的SAH患者的动脉瘤尺寸比不伴有ICH的患者大（P＜0.001），再破裂率更高（P＜0.001）。伴有ICH的SAH患者的不良预后与年龄和入院时的GCS评分有关。
年轻且入院时GCS评分良好可能与伴有ICH的SAH患者的良好预后相关，且伴有ICH的SAH可能容易再破裂。
