Fujii Y, Takeuchi S, Sasaki O, Minakawa T, Koike T, Tanaka R
Department of Neurosurgery, Niigata University, Japan.
J Neurosurg. 1996 Jan;84(1):35-42. doi: 10.3171/jns.1996.84.1.0035.
To determine the incidence of, and risk factors for, the occurrence of rebleeding between admission and early operation (ultra-early rebleeding) in patients with spontaneous subarachnoid hemorrhage (SAH), the authors reviewed the cases of 179 patients admitted within 24 hours after their last attack of SAH. Thirty-one (17.3%) of these patients had ultra-early rebleeding despite scheduling of early operation (within 24 hours after admission). The incidence of rebleeding significantly decreased as the time interval between the last attack and admission increased. Patients with rebleeding before admission, high systolic blood pressure, intracerebral or intraventricular hematoma, those in poor neurological condition on admission, and those who underwent angiography within 6 hours of the last SAH were significantly more likely to have ultra-early rebleeding than those without these factors. The incidence of rebleeding also significantly increased as levels of enhancement of platelet sensitivity and thrombin-antithrombin complex increased. Multivariate analysis revealed that the following three factors were independently associated with ultra-early rebleeding: the level of enhancement of platelet sensitivity; the time interval between the last attack and admission; and the level of thrombin-antithrombin complex. On the basis of these findings, the authors suggest that many of the risk factors for ultra-early rebleeding are interrelated. A particularly high risk of ultra-early rebleeding was observed in those patients 1) who had platelet hypoaggregability; 2) who were admitted shortly after their last SAH; and 3) whose thrombin-antithrombin complex levels were extremely high and were thus in severe clinical condition.
为了确定自发性蛛网膜下腔出血（SAH）患者在入院至早期手术（超早期再出血）期间再出血的发生率及危险因素，作者回顾了179例在最后一次SAH发作后24小时内入院患者的病例。尽管安排了早期手术（入院后24小时内），但其中31例（17.3%）患者发生了超早期再出血。随着最后一次发作与入院之间时间间隔的增加，再出血的发生率显著降低。入院前发生再出血、收缩压高、脑内或脑室内血肿、入院时神经状况差以及在最后一次SAH发作后6小时内接受血管造影的患者，比没有这些因素的患者更有可能发生超早期再出血。随着血小板敏感性增强和凝血酶 - 抗凝血酶复合物水平的升高，再出血的发生率也显著增加。多因素分析显示，以下三个因素与超早期再出血独立相关：血小板敏感性增强水平；最后一次发作与入院之间的时间间隔；以及凝血酶 - 抗凝血酶复合物水平。基于这些发现，作者认为超早期再出血的许多危险因素是相互关联的。在以下患者中观察到超早期再出血的风险特别高：1）血小板聚集功能低下的患者；2）在最后一次SAH发作后不久入院的患者；3）凝血酶 - 抗凝血酶复合物水平极高且临床状况严重的患者。
