Duangthongphon Pichayen, Souwong Bunika, Munkong Waranon, Kitkhuandee Amnat
Department of Surgery, The Center of Excellence of Neurovascular Intervention and Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Department of Radiology, The Center of Excellence of Neurovascular Intervention and Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Asian J Neurosurg. 2019 Jul-Sep;14(3):748-753. doi: 10.4103/ajns.AJNS_32_19.
In 2015, a protocol to prevent rebleeding was implemented to improve the outcome of patients with ruptured intracranial aneurysm. We performed a single-center retrospective analysis to compare the outcomes of pre/post using protocol.
Over a 3-year period, 208 patients with ruptured cerebral aneurysm were treated at our institution. The protocol for preventing rebleeding was initiated in 2015. We compared the two cohorts between the group of patients before initiating the protocol ( = 104) and after initiating the protocol ( = 104). We analyzed the protocol for preventing rebleeding which consisted of absolute bed rest, adequate pain control, avoiding stimuli (R), keeping euvolemia (E), preoperative systolic blood pressure <160 mmHg and within 140-180 mmHg after definite treatment (S), a short course (<72 h) of intravenous transaminic acid, and aneurysm treatment as early as possible (T). Outcomes are presented as in-hospital rebleeding, delayed cerebral ischemia (DCI), and proportion of unfavorable outcomes (score of 4-6 on a modified Rankin scale at 6 and 12 months).
Postprotocol, there was a reduction in the incidence of in-hospital rebleeding from 6.7% to 2.8% ( = 0.20, odds ratio [OR] = 0.4, 95% confidence interval [CI] = 0.10-1.63) and in the proportion of patients who presented with good WFNS grades (1-3) with unfavorable clinical outcomes at 12 months from 27.0% to 12.8% ( = 0.03, OR = 0.40, 95% CI = 0.17-0.95). The DCI experienced a significant reduction from 44.2% to 7.7% ( < 0.001, OR = 0.10, 95% CI = 0.04-0.23), and their 180-day mortality rate in good WFNS grades patients decreased from 16.3% to 8.8% (hazard ratio 0.80, 95% CI = 0.28-2.28).
Ruptured cerebral aneurysm patients benefit from this protocol due to its ability to reduce the incidence of DCI and reduce unfavorable outcome on good WFNS grade patients.
2015年实施了一项预防再出血的方案，以改善颅内动脉瘤破裂患者的治疗效果。我们进行了一项单中心回顾性分析，以比较使用该方案前后的治疗效果。
在3年期间，我们机构共治疗了208例脑动脉瘤破裂患者。预防再出血的方案于2015年开始实施。我们比较了方案实施前（n = 104）和实施后（n = 104）两组患者。我们分析了预防再出血的方案，该方案包括绝对卧床休息、充分的疼痛控制、避免刺激（R）、维持血容量正常（E）、术前收缩压<160 mmHg以及明确治疗后收缩压维持在140 - 180 mmHg（S）、短期（<72小时）静脉输注氨基转氨酶，以及尽早进行动脉瘤治疗（T）。结果以院内再出血、迟发性脑缺血（DCI）以及不良结局的比例（改良Rankin量表在6个月和12个月时评分为4 - 6分）来呈现。
方案实施后，院内再出血发生率从6.7%降至2.8%（P = 0.20，优势比[OR] = 0.4，95%置信区间[CI] = 0.10 - 1.63），12个月时WFNS分级良好（1 - 3级）但临床结局不良的患者比例从27.0%降至12.8%（P = 0.03，OR = 0.40，95% CI = 0.17 - 0.95）。DCI显著减少，从44.2%降至7.7%（P < 0.001，OR = 0.10，95% CI = 0.04 - 0.23），WFNS分级良好的患者180天死亡率从16.3%降至8.8%（风险比0.80，95% CI = 0.28 - 2.28）。
脑动脉瘤破裂患者受益于该方案，因为它能够降低DCI的发生率，并减少WFNS分级良好患者的不良结局。
