Vermeij F H, Hasan D, Vermeulen M, Tanghe H L, van Gijn J
Department of Neurology, University Hospital Rotterdam Dijkzigt, The Netherlands.
Neurology. 1994 Oct;44(10):1851-5. doi: 10.1212/wnl.44.10.1851.
We studied the predictive factors for deterioration from hydrocephalus that developed during the first 28 days after admission in 660 patients following aneurysmal subarachnoid hemorrhage (SAH). Deterioration from hydrocephalus was defined as deterioration of consciousness with no detectable cause other than hydrocephalus confirmed by a repeat CT with a bicaudate index exceeding the 95th percentile for age. Deterioration from hydrocephalus occurred in 143 (22%) of the 660 patients. The variables included in the analysis were sex, age, loss of consciousness at ictus, sum score on the Glasgow Coma Scale on admission, sum score of cisternal blood and presence of ventricular blood on initial CT, hydrocephalus on initial CT, confirmed aneurysm, rebleeding, delayed cerebral ischemia, and treatment with tranexamic acid for 4 (short-term treatment) or 28 (long-term treatment) days. In a multivariate analysis with the Cox proportional hazards model incorporating fixed and time-dependent covariates, sum score of cisternal blood on initial CT (hazard ratio 3.15, p < 0.000001), presence of ventricular blood on initial CT (hazard ratio 1.66, p = 0.004), hydrocephalus on initial CT (hazard ratio 3.37, p < 0.000001), and long-term treatment with tranexamic acid (hazard ratio 2.40, p < 0.000001) were significantly related with the development of hydrocephalus. We conclude that a high amount of blood after SAH and delay of the resorption of cisternal and ventricular blood caused by long-term treatment with tranexamic acid increases the risk of deterioration from hydrocephalus after SAH.
我们研究了660例动脉瘤性蛛网膜下腔出血（SAH）患者入院后28天内发生脑积水病情恶化的预测因素。脑积水导致的病情恶化定义为意识恶化，且排除其他可检测到的病因，通过重复CT检查证实存在脑积水，双尾状核指数超过年龄的第95百分位数。660例患者中有143例（22%）因脑积水出现病情恶化。分析中纳入的变量包括性别、年龄、发病时意识丧失、入院时格拉斯哥昏迷量表总分、初始CT上脑池积血总分及脑室积血情况、初始CT上的脑积水、确诊的动脉瘤、再出血、迟发性脑缺血以及氨甲环酸治疗4天（短期治疗）或28天（长期治疗）。在纳入固定和时间依赖性协变量的Cox比例风险模型的多变量分析中，初始CT上脑池积血总分（风险比3.15，p<0.000001）、初始CT上存在脑室积血（风险比1.66，p = 0.004）、初始CT上的脑积水（风险比3.37，p<0.000001）以及氨甲环酸长期治疗（风险比2.40，p<0.000001）与脑积水的发生显著相关。我们得出结论，SAH后大量出血以及氨甲环酸长期治疗导致脑池和脑室积血吸收延迟会增加SAH后脑积水病情恶化的风险。
