Department of Neurosurgery, The Third People's Hospital of Datong, Datong, 037008, Shanxi province, China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.
Chin J Traumatol. 2024 Dec;27(6):328-333. doi: 10.1016/j.cjtee.2023.11.004. Epub 2023 Nov 28.
To explore the effect of green channel for stroke patients on the treatment of severe aneurysmal subarachnoid hemorrhage.
This is a retrospective case-control study. The clinical data of patients with severe aneurysmal subarachnoid hemorrhage admitted to the emergency department of our hospital from January 2015 to June 2022 were retrospectively analyzed. Patients diagnosed with subarachnoid hemorrhage, confirmed intracranial aneurysm by preoperative CT angiography or digital subtraction, graded Hunt-Hess grade III, IV, and V, < 72 h from the onset to the time of consultation received surgical treatment in our hospital were included in this study. Patients with serious underlying diseases, such as heart, liver, kidney diseases, or malignant tumors, traumatic subarachnoid hemorrhage, previous history of cerebral hemorrhage, and incomplete data were excluded. The control group included patients with severe aneurysmal subarachnoid hemorrhage admitted from January 2015 to December 2018 before the establishment of the green channel for stroke patients, and the observation group included patients with severe aneurysmal subarachnoid hemorrhage admitted from January 2019 to June 2022 after the establishment of the green channel. The control group received routine treatment in the emergency department; the observation group received improved treatment of green channel for stroke patients. Gender, age, Hunt-Hess grade on admission, modified Rankin scale (mRS) on admission, aneurysm location, aneurysm size and whether accompanied by intracerebral hemorrhage, the time from onset to emergency department, the time from emergency department to vascular diagnostic examination, the time from onset to surgery, the time from emergency department to surgery, the time from hospital admission to surgery, length of hospital stay, complications, treatment effect were analyzed and compared between the 2 groups. SPSS 23.0 software was utilized to conduct comparisons between the 2 groups. The t-test, Chi-square test, or Mann-Whitney U test was chosen based on the data type. Statistical significance was established when p < 0.05.
A total of 71 patients were included in this study, of whom 37 were in the control group and 34 were in the observation group. There were no statistical differences in age, gender, Hunt-Hess grade, mRS scores, aneurysm location, aneurysm size, intracerebral hemorrhage, the time from onset to emergency department, length of hospital stay, complications between the observation group and the control group (all p > 0.05). The time (min) from visit to vascular diagnostic test (60.50 vs. 120.00, p = 0.027), the time (min) from onset to surgery (1792.00 vs. 2868.00, p = 0.023), the time (min) from emergency department to surgery (1568.50 vs. 2778.00, p = 0.016), the time (min) from hospital admission to surgery (1188.50 vs. 2708.00, p = 0.043), all of them were shorter in the observation group than those in the control group. The relative values of admission and 7-day postoperative mRS scores and the relative values of admission and discharge mRS scores ≥ 2 were used as the criteria for determining better efficacy, and the treatment effect was better than that in the control group, and the differences were statistically significant (admission to 7 days postoperative mRS score ≥ 2, 17 (50.0 %) vs. 8 (21.6 %), p = 0.012; admission to discharge mRS score ≥ 2, 19 (55.9 %) vs. 11 (29.7 %), p = 0.026).
The green channel for stroke patients with severe aneurysmal subarachnoid hemorrhage can effectively shorten the time from arrival at the emergency department to vascular diagnostic examination and the time from the emergency department to surgery, and achieve a better therapeutic effect, which is worth popularizing and applying.
探讨绿色通道对治疗重症颅内破裂动脉瘤性蛛网膜下腔出血的效果。
这是一项回顾性病例对照研究。回顾性分析 2015 年 1 月至 2022 年 6 月我院急诊收治的重度颅内破裂动脉瘤性蛛网膜下腔出血患者的临床资料。术前 CT 血管造影或数字减影证实颅内动脉瘤，Hunt-Hess 分级Ⅲ、Ⅳ、Ⅴ级，发病至就诊时间<72 h，在我院接受手术治疗的患者纳入本研究。排除有严重基础疾病（如心、肝、肾疾病或恶性肿瘤）、外伤性蛛网膜下腔出血、既往脑出血病史和资料不完整的患者。对照组为 2015 年 1 月至 2018 年 12 月在建立卒中患者绿色通道前我院收治的重度颅内破裂动脉瘤性蛛网膜下腔出血患者，观察组为 2019 年 1 月至 2022 年 6 月在建立卒中患者绿色通道后我院收治的重度颅内破裂动脉瘤性蛛网膜下腔出血患者。对照组在急诊科接受常规治疗，观察组接受改良卒中患者绿色通道治疗。比较两组患者的性别、年龄、入院时的 Hunt-Hess 分级、入院时的改良 Rankin 量表（mRS）评分、动脉瘤位置、动脉瘤大小及是否伴发颅内出血、发病至就诊时间、从就诊至血管诊断检查时间、从发病至手术时间、从就诊至手术时间、从入院至手术时间、住院时间、并发症、治疗效果。采用 SPSS 23.0 软件进行组间比较。根据数据类型选择 t 检验、卡方检验或 Mann-Whitney U 检验。当 p<0.05 时为差异有统计学意义。
本研究共纳入 71 例患者，其中对照组 37 例，观察组 34 例。两组患者的年龄、性别、Hunt-Hess 分级、mRS 评分、动脉瘤位置、动脉瘤大小、颅内出血、发病至就诊时间、住院时间、并发症比较，差异均无统计学意义（均 p>0.05）。观察组就诊至血管诊断检查时间（60.50 比 120.00，p=0.027）、从发病至手术时间（1792.00 比 2868.00，p=0.023）、从就诊至手术时间（1568.50 比 2778.00，p=0.016）、从入院至手术时间（1188.50 比 2708.00，p=0.043）均较对照组缩短。以入院和 7 天术后 mRS 评分≥2、入院和出院 mRS 评分≥2 为判定治疗效果更好的标准，观察组治疗效果优于对照组，差异均有统计学意义（入院至 7 天术后 mRS 评分≥2，17 例（50.0%）比 8 例（21.6%），p=0.012；入院至出院 mRS 评分≥2，19 例（55.9%）比 11 例（29.7%），p=0.026）。
绿色通道对重症颅内破裂动脉瘤性蛛网膜下腔出血患者能有效缩短从就诊至血管诊断检查和从就诊至手术的时间，达到更好的治疗效果，值得推广应用。
