Broderick J P, Brott T G, Duldner J E, Tomsick T, Leach A
Department of Neurology, University of Cincinnati Medical Center, OH 45267-0525.
Stroke. 1994 Jul;25(7):1342-7. doi: 10.1161/01.str.25.7.1342.
The goal of this study was to determine the causes of mortality and morbidity after subarachnoid hemorrhage.
We identified all first-ever spontaneous subarachnoid hemorrhages that occurred in the nearly 1.3 million population of greater Cincinnati during 1988.
Thirty-day mortality for subarachnoid hemorrhage was 45% (36 of 80 cases). Of the 36 deaths, 22 (61%) died within 2 days of onset; 21 of these deaths were due to the initial hemorrhage, and one death was due to rebleeding documented by computer tomography. Nine of the remaining 14 deaths after day 2 were caused by the initial hemorrhage (2 cases) or rebleeding (7 cases). Volume of subarachnoid hemorrhage was a powerful predictor of 30-day morality (P = .0001). Only 3 of the 29 patients with a volume of subarachnoid hemorrhage of 15 cm3 or less died before 30 days. Two of these 3 patients died from documented rebleeding; the third had 87 cm3 of additional intraventricular hemorrhage. Delayed arterial vasospasm contributed to only 2 of all 36 deaths.
Most deaths after subarachnoid hemorrhage occur very rapidly and are due to the initial hemorrhage. Rebleeding is the most important preventable cause of death in hospitalized patients. In a large representative metropolitan population, delayed arterial vasospasm plays a very minor role in mortality caused by subarachnoid hemorrhage.
本研究旨在确定蛛网膜下腔出血后的死亡和发病原因。
我们确定了1988年在大辛辛那提近130万人口中发生的所有首次自发性蛛网膜下腔出血病例。
蛛网膜下腔出血的30天死亡率为45%（80例中的36例）。在这36例死亡病例中，22例（61%）在发病后2天内死亡；其中21例死亡是由于初次出血，1例死亡是由于计算机断层扫描证实的再出血。在第2天后的其余14例死亡病例中，9例是由初次出血（2例）或再出血（7例）引起的。蛛网膜下腔出血量是30天死亡率的有力预测指标（P = .0001）。蛛网膜下腔出血量为15 cm³或更少的29例患者中，只有3例在30天前死亡。这3例患者中有2例死于记录在案的再出血；第3例有87 cm³的额外脑室内出血。延迟性动脉血管痉挛仅导致了所有36例死亡中的2例。
蛛网膜下腔出血后的大多数死亡发生得非常迅速，是由初次出血引起的。再出血是住院患者死亡最重要的可预防原因。在一个具有代表性的大都市人群中，延迟性动脉血管痉挛在蛛网膜下腔出血导致的死亡中所起的作用非常小。
