Hillman J, von Essen C, Leszniewski W, Johansson I
Department of Surgery, University Hospital, Linköping, Sweden.
J Neurosurg. 1988 Jun;68(6):901-7. doi: 10.3171/jns.1988.68.6.0901.
Knowledge of the local incidence of aneurysm rupture permits the conclusion that almost every patient in the population of 933,800 persons served by the authors' institution who was stricken by this catastrophe and survived long enough to be transported was treated at this center (121 patients during 34 months). Of these, 9.1% were admitted late (greater than 72 hours after subarachnoid hemorrhage (SAH]; of the remaining cases, 94.5% were seen within 24 hours and 50% within 6 hours post-SAH. Of the 121 patients, 10% were neurologically devastated on arrival, a late operation was planned for 19%, and the earliest possible surgery and nimodipine administration was selected for 71%. In this latter group, 50% of the operations were begun within 24 hours and 76% within 48 hours post-SAH. Sixty percent of all mortality and morbidity could be linked to the initial aneurysm bleed. The remaining 40% could be ascribed to potentially avoidable causes of unfavorable outcome. No less than 9.6% of all patients admitted within 24 hours after SAH suffered from "ultra-early" rebleeding during transportation or preparation for operation. The mortality rate from such rebleeding was 7.4%, compared with the 9.1% combined mortality rate from complications and late ischemia.
了解动脉瘤破裂的当地发病率后可得出结论，在作者所在机构服务的933,800人的人群中，几乎每一位遭受此次灾难并存活足够长时间以被转运的患者都在该中心接受了治疗（34个月内有121例患者）。其中，9.1%的患者入院较晚（蛛网膜下腔出血（SAH）后超过72小时）；在其余病例中，94.5%在SAH后24小时内就诊，50%在SAH后6小时内就诊。在这121例患者中，10%到达时神经功能严重受损，19%计划进行晚期手术，71%选择尽早进行手术并给予尼莫地平。在后一组中，50%的手术在SAH后24小时内开始，76%在48小时内开始。所有死亡和发病病例中有60%可归因于最初的动脉瘤出血。其余40%可归因于可能避免的不良结局原因。在SAH后24小时内入院的所有患者中，不少于9.6%在转运或手术准备期间发生“超早期”再出血。这种再出血的死亡率为7.4%，而并发症和晚期缺血的综合死亡率为9.1%。
