颅内动脉瘤破裂行显微手术修复的动脉瘤性蛛网膜下腔出血患者围手术期护理的全球综述。
A Global Review of the Perioperative Care of Patients With Aneurysmal Subarachnoid Hemorrhage Undergoing Microsurgical Repair of Ruptured Intracerebral Aneurysm.
作者信息
Lele Abhijit V, Shiferaw Ananya Abate, Theard Marie Angele, Vavilala Monica S, Tavares Cristiane, Han Ruquan, Assefa Denekew, Dagne Alemu Mihret, Mahajan Charu, Tandon Monica S, Karmarkar Neeta V, Singhal Vasudha, Lamsal Ritesh, Athiraman Umeshkumar
机构信息
Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
Department of Anesthesiology, University of Addis Ababa, Addis Ababa, Ethiopia.
出版信息
J Neurosurg Anesthesiol. 2024 Apr 1;36(2):164-171. doi: 10.1097/ANA.0000000000000913. Epub 2023 Apr 19.
INTRODUCTION
To describe the perioperative care of patients with aneurysmal subarachnoid hemorrhage (aSAH) who undergo microsurgical repair of a ruptured intracerebral aneurysm.
METHODS
An English language survey examined 138 areas of the perioperative care of patients with aSAH. Reported practices were categorized as those reported by <20%, 21% to 40%, 41% to 60%, 61% to 80%, and 81% to 100% of participating hospitals. Data were stratified by Worldbank country income level (high-income or low/middle-income). Variation between country-income groups and between countries was presented as an intracluster correlation coefficient (ICC) and 95% confidence interval (CI).
RESULTS
Forty-eight hospitals representing 14 countries participated in the survey (response rate 64%); 33 (69%) hospitals admitted ≥60 aSAH patients per year. Clinical practices reported by 81 to 100% of the hospitals included placement of an arterial catheter, preinduction blood type/cross match, use of neuromuscular blockade during induction of general anesthesia, delivering 6 to 8 mL/kg tidal volume, and checking hemoglobin and electrolyte panels. Reported use of intraoperative neurophysiological monitoring was 25% (41% in high-income and 10% in low/middle-income countries), with variation between Worldbank country-income group (ICC 0.15, 95% CI 0.02-2.76) and between countries (ICC 0.44, 95% CI 0.00-0.68). The use of induced hypothermia for neuroprotection was low (2%). Before aneurysm securement, variable in blood pressure targets was reported; systolic blood pressure 90 to 120 mm Hg (30%), 90 to 140 mm Hg (21%), and 90 to 160 mmHg (5%). Induced hypertension during temporary clipping was reported by 37% of hospitals (37% each in high and low/middle-income countries).
CONCLUSIONS
This global survey identifies differences in reported practices during the perioperative management of patients with aSAH.
引言
描述接受破裂性脑内动脉瘤显微手术修复的动脉瘤性蛛网膜下腔出血（aSAH）患者的围手术期护理。
方法
一项英文调查研究了aSAH患者围手术期护理的138个方面。报告的做法分为参与医院中报告率低于20%、21%至40%、41%至60%、61%至80%和81%至100%的几类。数据按世界银行国家收入水平（高收入或低/中等收入）分层。国家收入组之间和国家之间的差异以组内相关系数（ICC）和95%置信区间（CI）表示。
结果
来自14个国家的48家医院参与了调查（回复率64%）；33家（69%）医院每年收治≥60例aSAH患者。81%至100%的医院报告的临床做法包括放置动脉导管、诱导前血型/交叉配血、全身麻醉诱导期间使用神经肌肉阻滞剂、给予6至8 mL/kg潮气量以及检查血红蛋白和电解质指标。报告的术中神经生理监测使用率为25%（高收入国家为41%，低/中等收入国家为10%），世界银行国家收入组之间（ICC 0.15，95% CI 0.02 - 2.76）和国家之间（ICC 0.44，95% CI 0.00 - 0.68）存在差异。用于神经保护的诱导性低温使用率较低（2%）。在动脉瘤夹闭前，报告的血压目标存在差异；收缩压90至120 mmHg（30%）、90至140 mmHg（21%）和90至160 mmHg（5%）。37%的医院报告在临时夹闭期间进行诱导性高血压治疗（高收入国家和低/中等收入国家均为37%）。
结论
这项全球调查确定了aSAH患者围手术期管理中报告做法的差异。
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