1University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, and.
2Institute for Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, University of Cologne, Germany.
J Neurosurg. 2020 Apr 17;134(3):1182-1189. doi: 10.3171/2020.2.JNS20148. Print 2021 Mar 1.
Timely aneurysm occlusion and neurointensive care treatment are key principles in the management of aneurysmal subarachnoid hemorrhage (aSAH) to prevent secondary brain injury. Patients with early (EHA) and delayed hospital admission (DHA) were compared in terms of clinical presentation, treatment strategies, aSAH-related complications, and outcome.
In this retrospective study, consecutive aSAH patients were treated at a single neurovascular center between 2009 and 2019. Propensity score matching was performed to account for divergent baseline characteristics.
Among 509 included patients, 55 were admitted more than 48 hours after ictus (DHA group). DHA patients were significantly younger (52 ± 11 vs 56 ± 14 years, p = 0.03) and had lower World Federation of Neurosurgical Societies scores (p < 0.01) than EHA patients. In 54.5% of the cases, DHA patients presented with neurological deterioration or aggravated symptoms. Propensity score matching revealed a higher vasospastic infarction rate in the DHA group (41.5%) than in the EHA group (22.6%) (p = 0.04). A similar portion of patients in both groups achieved favorable outcome at midterm follow-up (77.3% vs 73.6%, p = 0.87). DHA patients (62.3%) received conventional coiling more often than EHA patients (41.5%) (p = 0.03).
DHA patients are at an increased risk of cerebral infarction. Nevertheless, state-of-the-art neurointensive care treatment can result in a good clinical outcome.
及时进行动脉瘤闭塞和神经重症监护治疗是蛛网膜下腔出血（aSAH）管理的关键原则，可预防继发性脑损伤。本研究旨在比较早期（EHA）和延迟性（DHA）入院的患者的临床表现、治疗策略、aSAH 相关并发症和结局。
本回顾性研究纳入了 2009 年至 2019 年期间在单一神经血管中心治疗的连续 aSAH 患者。采用倾向评分匹配来平衡基线特征差异。
509 例纳入患者中，55 例在发病后 48 小时以上入院（DHA 组）。DHA 组患者明显更年轻（52 ± 11 岁 vs. 56 ± 14 岁，p = 0.03），世界神经外科学会评分更低（p < 0.01）。在 54.5%的情况下，DHA 患者出现神经功能恶化或症状加重。倾向评分匹配显示 DHA 组的血管痉挛性梗死发生率（41.5%）高于 EHA 组（22.6%）（p = 0.04）。两组患者在中期随访时均有相似比例的患者获得良好结局（77.3% vs. 73.6%，p = 0.87）。DHA 组（62.3%）比 EHA 组（41.5%）更常接受传统的弹簧圈治疗（p = 0.03）。
DHA 患者发生脑梗死的风险增加。然而，先进的神经重症监护治疗可以带来良好的临床结局。
