Unidad de Cuidados Intensivos. Complejo Hospitalario Universitario de A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), Universidad de A Coruña, A Coruña, España.
Unidad de Cuidados Intensivos. Complejo Hospitalario Universitario de A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), Universidad de A Coruña, A Coruña, España.
Neurocirugia (Astur : Engl Ed). 2021 Jan-Feb;32(1):10-20. doi: 10.1016/j.neucir.2020.03.007. Epub 2020 May 23.
Spontaneous subarachnoid haemorrhage is a rare cause of stroke, but it causes great socioeconomic impact and high morbidity and mortality. The aim of this study is to describe the clinical profile and evolution of a series of patients with SAH admitted to a tertiary hospital, as well as the diagnostic and therapeutic management.
Retrospective study of 536 patients diagnosed with SAH admitted to the ICU of the Hospital Universitario de A Coruña between 2003 and 2013 (Age: 56.9±14.1 years, female/male ratio: 1.5:1). Demographic characteristics, risk factors, aetiologies and clinical signs, prognostic scales, diagnostic tests and treatment were collected. A comparative analysis was made between the general series and subgroups of patients with aneurysmal (SAH-A) and idiopathic (SAH-I) subarachnoid haemorrhage.
There were 49.0±15.1 patients/year (2013 incidence: 4.3/100,000 inhabitants). 60.3% presented Glasgow Coma Scale 14-15, with scarce symptomatology (Hunt-Hess I-II 61.9%, World Federation Neurosurgeons Scale I-II 60.4%). 50.7% presented Fisher IV. SAH-A was diagnosed in 78.3% (n=396); perimesencephalic subarachnoid haemorrhage (SAH-PM) in 3.2%; and SAH-I in 17.9%. During the study period there was an increase in the prevalence of aneurysms, causing an increased number of surgeries in recent years. Both SAH-A and SAH-I presented greater severity upon admission. Patients with SAH-A had higher percentage of complications and mortality, with lesser degree of independence at 6 and 12 months.
The incidence of SAH appears to have decreased in recent years, with SAH-I comprising 17.9% of the cases. Patients with SAH-I have better prognosis and lower risk of complications, highlighting the benignity of SAH-PM.
自发性蛛网膜下腔出血是一种罕见的中风原因，但它会造成巨大的社会经济影响和高发病率及死亡率。本研究的目的是描述一组因蛛网膜下腔出血而入住一家三级医院的患者的临床特征和演变，并描述其诊断和治疗管理。
回顾性研究了 2003 年至 2013 年间入住拉科鲁尼亚大学医院重症监护病房的 536 名蛛网膜下腔出血患者（年龄：56.9±14.1 岁，女性/男性比例：1.5:1）。收集了人口统计学特征、危险因素、病因和临床体征、预后评分、诊断性检查和治疗情况。对一般系列和蛛网膜下腔出血伴动脉瘤（SAH-A）和特发性（SAH-I）亚组的患者进行了比较分析。
每年有 49.0±15.1 名患者（2013 年发病率：4.3/100,000 居民）。60.3%的患者格拉斯哥昏迷量表评分为 14-15 分，症状较轻（Hunt-Hess I-II 61.9%，世界神经外科学联合会 I-II 60.4%）。50.7%的患者为 Fisher IV 级。78.3%（n=396）诊断为蛛网膜下腔出血伴动脉瘤；中脑周围蛛网膜下腔出血（SAH-PM）3.2%；特发性蛛网膜下腔出血 17.9%。在研究期间，动脉瘤的患病率有所增加，导致近年来手术数量增加。SAH-A 和 SAH-I 入院时的严重程度都较高。SAH-A 患者并发症和死亡率较高，6 个月和 12 个月时的独立性较差。
近年来，蛛网膜下腔出血的发病率似乎有所下降，特发性蛛网膜下腔出血占病例的 17.9%。特发性蛛网膜下腔出血患者的预后较好，并发症风险较低，这突出了中脑周围蛛网膜下腔出血的良性。
