Liu Haonan, Xu Qian, Yang Hua
Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
Department of Medical Administration, Yancheng No. 1 People's Hospital, Yancheng, China.
World Neurosurg. 2023 May;173:e766-e777. doi: 10.1016/j.wneu.2023.03.011. Epub 2023 Mar 11.
To investigate poor outcomes of aneurysmal subarachnoid hemorrhage (aSAH) and compare the clinicodemographic characteristics, imaging features, intervention strategies, laboratory tests, and complications of patients with good and poor outcomes to identify potential risk factors.
We retrospectively analyzed patients with aSAH who underwent surgery in Guizhou, China, between June 1, 2014, and September 1, 2022. The Glasgow Outcome Scale was used to evaluate outcomes at discharge, with scores of 1-3 and 4-5 considered poor and good, respectively. Clinicodemographic characteristics, imaging features, intervention strategies, laboratory tests, and complications were compared between patients with good and poor outcomes. Multivariate analysis was used to determine independent risk factors for poor outcomes. The poor outcome rate of each ethnic group was compared.
Of 1169 patients, 348 were ethnic minorities, 134 underwent microsurgical clipping, and 406 had poor outcomes at discharge. Patients with poor outcomes were older, represented fewer ethnic minorities, had a history of comorbidities, experienced more complications, and underwent microsurgical clipping. The top 3 types of aneurysms were anterior, posterior communicating, and middle cerebral artery aneurysms.
Outcomes at discharge varied according to ethnic group. Han patients had worse outcomes. Age, loss of consciousness at onset, systolic blood pressure on admission, Hunt-Hess grade 4-5 on admission, epileptic seizures, modified Fisher grade 3-4, microsurgical clipping, size of the ruptured aneurysm, and cerebrospinal fluid replacement were independent risk factors for aSAH outcomes.
探讨动脉瘤性蛛网膜下腔出血（aSAH）的不良预后，并比较预后良好和不良患者的临床人口统计学特征、影像学特征、干预策略、实验室检查及并发症，以确定潜在危险因素。
我们回顾性分析了2014年6月1日至2022年9月1日在中国贵州接受手术的aSAH患者。采用格拉斯哥预后量表评估出院时的预后，评分1 - 3分和4 - 5分分别视为预后不良和良好。比较了预后良好和不良患者的临床人口统计学特征、影像学特征、干预策略、实验室检查及并发症。采用多因素分析确定不良预后的独立危险因素。比较了各民族的不良预后率。
1169例患者中，348例为少数民族，134例接受了显微手术夹闭，406例出院时预后不良。预后不良的患者年龄较大，少数民族患者较少，有合并症病史，并发症较多，且接受了显微手术夹闭。动脉瘤的前三位类型为前交通、后交通和大脑中动脉动脉瘤。
出院时的预后因种族而异。汉族患者预后较差。年龄、发病时意识丧失、入院时收缩压、入院时Hunt - Hess分级4 - 5级、癫痫发作、改良Fisher分级3 - 4级、显微手术夹闭、破裂动脉瘤大小及脑脊液置换是aSAH预后的独立危险因素。
