Yamaguchi Susumu, Izumo Tsuyoshi, Sato Izumi, Morofuji Yoichi, Kaminogo Makio, Anda Takeo, Horie Nobutaka, Matsuo Takayuki
Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
Department of Clinical Epidemiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Acta Neurochir (Wien). 2023 Oct;165(10):2855-2864. doi: 10.1007/s00701-023-05705-4. Epub 2023 Jul 11.
Aneurysm rebleeding is fatal in patients with aneurysmal subarachnoid hemorrhage (aSAH). We aimed to investigate whether immediate general anesthesia (iGA) management in the emergency room, upon arrival, prevents rebleeding after admission and reduces mortality following aSAH.
The clinical data of 3033 patients with World Federation of Neurosurgical Societies (WFNS) grade 1, 2, or 3 aSAH from the Nagasaki SAH Registry Study between 2001 and 2018 were retrospectively analyzed. iGA was defined as sedation and analgesia using intravenous anesthetics and opioids combined with intubation induction. We calculated crude and adjusted odds ratios to evaluate the associations between iGA and the risk of rebleeding/death using multivariable logistic regression models with fully conditional specification for multiple imputations. In the analysis of the relationship between iGA and death, we excluded patients with aSAH who died within 3 days after the onset of symptoms.
Of the 3033 patients with aSAH who met the eligibility criteria, 175 patients (5.8%) received iGA (mean age, 62.4 years; 49 were male). Heart disease, WFNS grade, and lack of iGA were independently associated with rebleeding in the multivariable analysis with multiple imputations. Among the 3033 patients, 15 were excluded due to death within 3 days after the onset of symptoms. After excluding these cases, our analysis revealed that age, diabetes mellitus, history of cerebrovascular disease, WFNS grade, Fisher grade, lack of iGA, rebleeding, postoperative rebleeding, no shunt operation, and symptomatic spasm were independently associated with mortality.
Management by iGA was associated with a 0.28-fold decrease in the risks of both rebleeding and mortality in patients with aSAH, even after adjusting for the patient's history of diseases, comorbidities, and aSAH status. Thus, iGA can be a treatment for the prevention of rebleeding before aneurysmal obliteration treatment.
动脉瘤再出血对于动脉瘤性蛛网膜下腔出血（aSAH）患者来说是致命的。我们旨在研究在急诊室患者到达后立即进行全身麻醉（iGA）管理是否能预防入院后的再出血并降低aSAH后的死亡率。
回顾性分析了2001年至2018年期间来自长崎SAH注册研究的3033例世界神经外科联合会（WFNS）1、2或3级aSAH患者的临床资料。iGA定义为使用静脉麻醉药和阿片类药物并结合插管诱导进行镇静和镇痛。我们使用具有完全条件指定的多变量逻辑回归模型进行多次插补，计算粗比值比和调整后的比值比，以评估iGA与再出血/死亡风险之间的关联。在分析iGA与死亡之间的关系时，我们排除了症状发作后3天内死亡的aSAH患者。
在符合纳入标准的3033例aSAH患者中，175例（5.8%）接受了iGA（平均年龄62.4岁；49例为男性）。在进行多次插补的多变量分析中，心脏病、WFNS分级和未接受iGA与再出血独立相关。在这3033例患者中，有15例因症状发作后3天内死亡而被排除。排除这些病例后，我们的分析显示年龄、糖尿病、脑血管疾病史、WFNS分级、Fisher分级、未接受iGA、再出血、术后再出血、未进行分流手术和症状性痉挛与死亡率独立相关。
即使在调整了患者的疾病史、合并症和aSAH状态后，iGA管理也使aSAH患者的再出血和死亡风险降低了0.28倍。因此，iGA可作为动脉瘤闭塞治疗前预防再出血的一种治疗方法。
