Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Neurocrit Care. 2019 Oct;31(2):346-356. doi: 10.1007/s12028-019-00674-y.
We reviewed retrospectively the perioperative treatment of microsurgically resected brain arteriovenous malformations (bAVMs) at the neurosurgical department of Helsinki University Hospital between the years 2006 and 2014. We examined the performance of the treatment protocol and the incidence of delayed postoperative hemorrhage (DPH).
The Helsinki protocol for postoperative treatment of bAVMs was used for the whole patient cohort of 121. The patients who had subsequent DPH were reviewed in more detail.
Five out of 121 (4.1%) patients had DPH. These patients had a higher Spetzler-Martin grade (SMG) (p = 0.043) and a more complex venous drainage pattern (p = 0.003) as compared to those who had no postoperative bleed. Patients with DPH had 43% larger intravenous fluid intake in the neurosurgical intensive care unit (p = 0.052); they were all male (p = 0.040) and had longer stay in the intensive care unit (p = 0.022).
The Helsinki protocol for postoperative treatment of bAVMs was found to produce comparable results to a more complex treatment algorithm. DPH was associated with high SMG, complex venous drainage pattern, male gender and high intravenous fluid intake. Our findings support the use of SMG in defining patient's postoperative treatment as the DPHs in our study occurred in patients with grade 2-5.
我们回顾性分析了 2006 年至 2014 年间赫尔辛基大学附属医院神经外科显微切除脑动静脉畸形（bAVM）的围手术期治疗。我们研究了治疗方案的表现和迟发性术后出血（DPH）的发生率。
我们对整个 121 例患者队列使用了赫尔辛基 bAVM 术后治疗方案。我们对随后发生 DPH 的患者进行了更详细的回顾。
121 例患者中有 5 例（4.1%）发生 DPH。与无术后出血的患者相比，这些患者的 Spetzler-Martin 分级（SMG）更高（p=0.043），静脉引流模式更复杂（p=0.003）。发生 DPH 的患者在神经外科重症监护病房的静脉输液量增加了 43%（p=0.052）；他们均为男性（p=0.040），且在重症监护病房的停留时间更长（p=0.022）。
我们发现，用于 bAVM 术后治疗的赫尔辛基方案与更复杂的治疗算法产生了相当的结果。DPH 与高 SMG、复杂静脉引流模式、男性和高静脉输液量有关。我们的研究结果支持使用 SMG 来定义患者的术后治疗，因为我们研究中的 DPH 发生在 SMG 分级为 2-5 的患者中。
