Voellger Benjamin, Rupa Rosita, Arndt Christian, Carl Barbara, Nimsky Christopher
Department of Neurosurgery, University Hospital Marburg, 35033 Marburg, Germany.
Department of Anaesthesiology, University Hospital Marburg, 35033 Marburg, Germany.
Medicina (Kaunas). 2019 Nov 1;55(11):724. doi: 10.3390/medicina55110724.
To identify predictors of outcome after aneurysmal subarachnoid hemorrhage (aSAH) in our interdisciplinary setting. 176 patients who had been treated for aSAH by a team of neurosurgeons and neuroradiologists between 2009 and 2017 were analyzed retrospectively. Age, gender, clinical presentation according to the Hunt and Hess (H&H) grading on admission, overall clot burden, aneurysm localization, modality of aneurysm obliteration, early deterioration (ED), occurrence of vasospasm in transcranial Doppler ultrasonography, delayed cerebral ischemia (DCI), spasmolysis, decompressive craniectomy (DC), cerebrospinal fluid (CSF) shunt placement, deep vein thrombosis (DVT), pulmonary embolism (PE), severe cardiac events (SCE), mortality on Days 14, and 30 after admission, and outcome at one year after the hemorrhage according to the Glasgow Outcome Scale (GOS) were recorded. Chi square, Fisher's exact, Welch's t, and Wilcoxon rank sum served as statistical tests. Generalized linear models were fitted, and ordered logistic regression was performed. : SCE ( = 0.049) were a significant predictor of mortality at 14 days after aSAH, but not later during the first year after the hemorrhage. Clipping as opposed to coiling ( = 0.049) of ruptured aneurysms was a significant predictor of survival on Day 30 after aSAH, but not later during the first year after the hemorrhage, while coiling as opposed to clipping of ruptured aneurysms was significantly related to a lower frequency of DVT during hospitalization ( = 0.024). Aneurysms of the anterior circulation were significantly more often clipped, while aneurysms of the posterior circulation were significantly more often coiled ( < 0.001). Age over 70 years ( = 0.049), H&H grade on admission ( = 0.022), overall clot burden ( = 0.035), ED ( = 0.009), DCI ( = 0.013), DC ( = 0.0005), and CSF shunt placement ( = 0.038) proved to be predictive of long-term outcome after aSAH. Long-term results after clipping and coiling of ruptured aneurysms appear equal in an interdisciplinary setting that takes aneurysm localization, available staff, and equipment into account.
为了确定在我们多学科治疗环境下动脉瘤性蛛网膜下腔出血（aSAH）后的预后预测因素。回顾性分析了2009年至2017年间由神经外科医生和神经放射科医生团队治疗的176例aSAH患者。记录患者的年龄、性别、入院时根据Hunt和Hess（H&H）分级的临床表现、总的血凝块负荷、动脉瘤位置、动脉瘤闭塞方式、早期病情恶化（ED）、经颅多普勒超声检查中血管痉挛的发生情况、迟发性脑缺血（DCI）、解痉治疗、去骨瓣减压术（DC）、脑脊液（CSF）分流置入、深静脉血栓形成（DVT）、肺栓塞（PE）、严重心脏事件（SCE）、入院后第14天和第30天的死亡率以及出血后一年根据格拉斯哥预后量表（GOS）评估的预后。采用卡方检验、Fisher精确检验、Welch t检验和Wilcoxon秩和检验作为统计分析方法。拟合广义线性模型并进行有序逻辑回归分析。结果显示：SCE（P = 0.049）是aSAH后14天死亡率的显著预测因素，但在出血后第一年的后期不是。与血管内栓塞相比，破裂动脉瘤夹闭术（P = 0.049）是aSAH后30天生存的显著预测因素，但在出血后第一年的后期不是，而与破裂动脉瘤夹闭术相比，血管内栓塞术与住院期间较低的DVT发生率显著相关（P = 0.024）。前循环动脉瘤更常采用夹闭术，而后循环动脉瘤更常采用血管内栓塞术（P < 0.001）。年龄超过70岁（P = 0.049）、入院时的H&H分级（P = 0.022）、总的血凝块负荷（P = 0.035）、ED（P = 0.009）、DCI（P = 0.013）、DC（P = 0.0005）和CSF分流置入（P = 0.038）被证明是aSAH后长期预后的预测因素。在考虑动脉瘤位置、可用人员和设备的多学科治疗环境下，破裂动脉瘤夹闭术和血管内栓塞术的长期结果似乎相当。
