Han Yangyun, Ye Feng, Long Xiaodong, Li Aiguo, Xu Hong, Zou Linbo, Yang Yumin, You Chao
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China; Department of Neurosurgery, People's Hospital of Deyang City, Deyang, Sichuan, P.R. China.
Department of Neurosurgery, People's Hospital of Deyang City, Deyang, Sichuan, P.R. China.
World Neurosurg. 2018 Jul;115:e160-e171. doi: 10.1016/j.wneu.2018.03.219. Epub 2018 Apr 9.
It remains unknown if ultra-early (within 24 hours after onset) treatment can improve the prognosis in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH). We aimed to evaluate the effect of ultra-early treatment on functional outcomes and mortality in patients with poor-grade aSAH via a systematic review and meta-analysis.
We performed a literature search in the PubMed, MEDLINE, and Web of Science databases. Primary outcomes were death and functional outcome assessed at any time period. Secondary outcomes were the rebleeding rate before an aneurysm occlusion procedure and the incidence of intraoperative technique difficulty (ITD). The results are reported as odds ratio (OR) with 95% confidence interval (CI).
A total of 14 articles containing 1111 patients met our inclusion criteria and were included in our analysis. The pooled incidence was 47% (95% CI, 40%-54%) for favorable outcome across 13 studies, 26% (95% CI, 19%-32%) for mortality in 11 studies, 10% (95% CI, 3%-16%) for rebleeding in 5 studies, and 20% (95% CI, 10%-31%) for ITD in 5 studies after ultra-early treatment of poor-grade aSAH. Compared with delayed treatment (>24 hours), the ultra-early treatment failed to improve outcomes (OR, 1.23; 95% CI, 0.75-2.01; P = 0.40) or reduce mortality (OR, 0.84; 95% CI, 0.58-1.22; P = 0.45), but tended to prevent preoperative rebleeding (OR, 0.59; 95% CI, 0.32 to 1.07; P = 0.08) in 6, 4, and 4 case-control studies, respectively.
Our findings show no significant change both in functional outcome and mortality between ultra-early and delayed treatment although ultra-early treatment may be associated with lower rebleeding rate.
超早期（发病后24小时内）治疗能否改善低级别动脉瘤性蛛网膜下腔出血（aSAH）患者的预后尚不清楚。我们旨在通过系统评价和荟萃分析评估超早期治疗对低级别aSAH患者功能结局和死亡率的影响。
我们在PubMed、MEDLINE和Web of Science数据库中进行了文献检索。主要结局是在任何时间段评估的死亡和功能结局。次要结局是动脉瘤闭塞手术前的再出血率和术中技术难度（ITD）发生率。结果以比值比（OR）及95%置信区间（CI）报告。
共有14篇包含1111例患者的文章符合我们的纳入标准并纳入分析。在13项研究中，超早期治疗低级别aSAH后良好结局的合并发生率为47%（95%CI，40%-54%），11项研究中死亡率为26%（95%CI，19%-32%），5项研究中再出血率为10%（95%CI，3%-16%），5项研究中ITD发生率为20%（95%CI，10%-31%）。与延迟治疗（>24小时）相比，超早期治疗未能改善结局（OR，1.23；95%CI，0.75-2.01；P = 0.40）或降低死亡率（OR，0.84；95%CI，0.58-1.22；P = 0.45），但在6项、4项和4项病例对照研究中分别倾向于预防术前再出血（OR，0.59；95%CI，0.32至1.07；P = 0.08）。
我们的研究结果表明，尽管超早期治疗可能与较低的再出血率相关，但超早期治疗和延迟治疗在功能结局和死亡率方面均无显著变化。
