Intensive Care Unit, Hospital Maciel, ASSE - Montevideo, Uruguay.
Crit Care Sci. 2023 Dec 22;35(3):311-319. doi: 10.5935/2965-2774.20230119-en. eCollection 2023.
To determine the prevalence of sonographic vasospasm and delayed ischemic deficit in patients with aneurysmal subarachnoid hemorrhage, to evaluate the correlation between different tomographic scales and these complications, and to study prognostic factors in this group of patients.
This was a prospective study of patients admitted to the intensive care unit with a diagnosis of aneurysmal subarachnoid hemorrhage. The prevalence of sonographic vasospasm and radiological delayed cerebral ischemia was analyzed, as was the correlation between different tomographic scales and these complications.
A total of 57 patients were studied. Sixty percent of the patients developed sonographic vasospasm, which was significantly associated with delayed cerebral ischemia and mortality. The Claassen and Hijdra scales were better correlated with the development of cerebral vasospasm (areas under the curve of 0.78 and 0.68) than was Fisher's scale (0.62). Thirty-two patients (56.1%) developed cerebral infarction on CT; the significantly associated factors were poor clinical grade at admission (p = 0.04), sonographic vasospasm (p = 0.008) and severity of vasospasm (p = 0.015). Only the semiquantitative Hijdra scale was significantly correlated with the development of radiological delayed cerebral ischemia (p = 0.009). The patients who presented cerebral infarction had worse neurological evolution and higher mortality.
This is the first study in our environment on the subject. The Claassen and Hijdra tomographic scales showed better prognostic performance than the Fisher scale for the development of cerebral vasospasm. The finding of sonographic vasospasm could be a noninvasive criterion for the early detection of delayed cerebral ischemia and neurological deterioration in patients with aneurysmal subarachnoid hemorrhage.
确定蛛网膜下腔出血患者的超声血管痉挛和迟发性缺血性缺损的发生率，评估不同的影像学分级与这些并发症的相关性，并研究这组患者的预后因素。
这是一项对被诊断为蛛网膜下腔出血的重症监护病房患者进行的前瞻性研究。分析了超声血管痉挛和放射学迟发性脑缺血的发生率，以及不同影像学分级与这些并发症之间的相关性。
共研究了 57 例患者。60%的患者发生了超声血管痉挛，与迟发性脑缺血和死亡率显著相关。Claassen 和 Hijdra 量表与脑血管痉挛的发生相关性更好（曲线下面积分别为 0.78 和 0.68），而 Fisher 量表则较差（0.62）。32 例（56.1%）患者在 CT 上发生脑梗死；与脑梗死显著相关的因素是入院时的临床分级较差（p = 0.04）、超声血管痉挛（p = 0.008）和血管痉挛的严重程度（p = 0.015）。只有半定量的 Hijdra 量表与放射学迟发性脑缺血的发生显著相关（p = 0.009）。出现脑梗死的患者神经功能恶化更严重，死亡率更高。
这是我们环境中关于该主题的第一项研究。Claassen 和 Hijdra 影像学分级对脑血管痉挛的发生具有比 Fisher 分级更好的预后预测能力。超声血管痉挛的发现可能是蛛网膜下腔出血患者早期发现迟发性脑缺血和神经功能恶化的非侵入性标准。
