Schievink W I, Wijdicks E F, Piepgras D G, Chu C P, O'Fallon W M, Whisnant J P
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
J Neurosurg. 1995 May;82(5):791-5. doi: 10.3171/jns.1995.82.5.0791.
The first 48 hours after aneurysmal subarachnoid hemorrhage are critical in determining final outcome. However, most patients who die during this initial period are not included in hospital-based studies. We investigated the occurrence of subarachnoid hemorrhage in a population-based study to evaluate possible predictors of poor outcome. All patients diagnosed with aneurysmal subarachnoid hemorrhage between 1955 and 1984 were selected for analysis of mortality in the first 30 days using the medical record-linkage system employed for epidemiological studies in Rochester, Minnesota. One hundred and thirty-six patients were identified. The mean age of these 99 women and 37 men was 55 years. Rates for survival to 48 hours were 32% for the 19 patients with posterior circulation aneurysms, 77% for the 87 patients with anterior circulation aneurysms, and 70% for the 30 patients with a presumed aneurysm (p < 0.0001). Rates for survival to 30 days were 11%, 57%, and 53%, respectively, in these three patient groups (p < 0.0001). Clinical grade on admission to the hospital, the main variable predictive of death within 48 hours, was significantly worse in patients with posterior circulation aneurysms than in others (p < 0.0001). The prognosis of ruptured posterior circulation aneurysms is poor. The high early mortality explains why posterior circulation aneurysms are uncommon in most clinical series of patients with subarachnoid hemorrhage. The management of incidentally discovered intact posterior circulation aneurysms may be influenced by these findings.
动脉瘤性蛛网膜下腔出血后的最初48小时对于决定最终预后至关重要。然而，大多数在此初始阶段死亡的患者未被纳入基于医院的研究。我们在一项基于人群的研究中调查了蛛网膜下腔出血的发生情况，以评估预后不良的可能预测因素。利用明尼苏达州罗切斯特市用于流行病学研究的医疗记录链接系统，选取了1955年至1984年间所有诊断为动脉瘤性蛛网膜下腔出血的患者，分析其前30天的死亡率。共识别出136例患者。这99名女性和37名男性的平均年龄为55岁。19例后循环动脉瘤患者48小时生存率为32%，87例前循环动脉瘤患者为77%，30例疑似动脉瘤患者为70%（p<0.0001）。这三组患者30天生存率分别为11%、57%和53%（p<0.0001）。入院时的临床分级是48小时内死亡的主要预测变量，后循环动脉瘤患者的临床分级明显比其他患者差（p<0.0001）。破裂的后循环动脉瘤预后不良。早期高死亡率解释了为什么在大多数蛛网膜下腔出血患者的临床系列中后循环动脉瘤并不常见。这些发现可能会影响对偶然发现的未破裂后循环动脉瘤的处理。
