蛛网膜下腔出血的管理与结局的18年趋势：单中心经验
Eighteen-Year Trends in Subarachnoid Hemorrhage Management and Outcomes: A Single-Center Experience.
作者信息
Renaudier Marie, Degos Vincent, Pisanu Gianluca, Granger Benjamin, Abdennour Lamine, Tabillon Caroline, Hijazi Dany, Boch Anne-Laure, Mathon Bertrand, Clarençon Frédéric, Shotar Eimad, Puybasset Louis, Bernard Rémy, Jacquens Alice
机构信息
Department of Anaesthesia and Critical Care, Pitié-Salpêtrière Hospital, Paris, France.
Groupe de Recherche Clinique en Anesthésie Réanimation Médecine Périopératoire, Pitié-Salpêtrière Hospital, Paris, France.
出版信息
Neurocrit Care. 2025 Apr 28. doi: 10.1007/s12028-025-02268-3.
BACKGROUND
Although subarachnoid hemorrhage-related mortality has decreased in recent years due to improvements in treatment, data on the evolution of 1-year functional outcomes after subarachnoid hemorrhage are lacking. The objective of this study was to evaluate the evolution of patient management and their functional outcomes 1 year after subarachnoid hemorrhage over time in a single high-volume neurosurgical intensive care unit.
METHODS
In this observational retrospective study, all consecutive patients with aneurysmal subarachnoid hemorrhage admitted to our neurosurgical intensive care unit between 2002 and 2019 were included. A poor functional outcome was defined as a modified Rankin Scale score of 4-6. Linear regressions were performed, and relative risk reductions of a poor functional outcome were calculated.
RESULTS
Between 2002 and 2019, 1556 patients were included, of whom 329 (21%) had a poor functional outcome. Over time, the percentage of coiling procedures (p = 0.004) increased, and the percentage of delayed cerebral ischemia (p = 0.03) decreased. One-year mortality decreased over time (p < 0.001), whereas 1-year functional outcome improved (p = 0.002), with a relative risk reduction of poor functional outcomes of 38% (17-54%).
CONCLUSIONS
The 1-year functional outcome of patients with subarachnoid hemorrhage improved between 2002 and 2019, and mortality decreased.
背景
尽管近年来由于治疗方法的改进，蛛网膜下腔出血相关的死亡率有所下降，但缺乏关于蛛网膜下腔出血后1年功能转归演变的数据。本研究的目的是评估在一个高容量的神经外科重症监护病房中，蛛网膜下腔出血患者1年后随着时间推移的治疗管理演变及其功能转归。
方法
在这项观察性回顾性研究中，纳入了2002年至2019年间连续入住我们神经外科重症监护病房的所有动脉瘤性蛛网膜下腔出血患者。功能转归不良定义为改良Rankin量表评分为4 - 6分。进行线性回归分析，并计算功能转归不良的相对风险降低率。
结果
2002年至2019年间，共纳入1556例患者，其中329例（21%）功能转归不良。随着时间的推移，血管内栓塞治疗的比例增加（p = 0.004），迟发性脑缺血的比例下降（p = 0.03）。1年死亡率随时间下降（p < 0.001），而1年功能转归得到改善（p = 0.002），功能转归不良的相对风险降低了38%（17 - 54%）。
结论
2002年至2019年间，蛛网膜下腔出血患者的1年功能转归得到改善，死亡率下降。
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