Gruber A, Reinprecht A, Görzer H, Fridrich P, Czech T, Illievich U M, Richling B
Department of Neurosurgery, University of Vienna, Austria.
J Neurosurg. 1998 Jan;88(1):28-37. doi: 10.3171/jns.1998.88.1.0028.
This observational study is based on a consecutive series of 207 patients with aneurysmal subarachnoid hemorrhage who were treated within 7 days of their most recent bleed. The purpose of the study was to evaluate the effect of respiratory failure on neurological outcome.
Pulmonary function was assessed by determination of parameters describing pulmonary oxygen transport and exchange, by using composite scores for quantification of lung injury (lung injury score [LIS]) and mechanical ventilator settings (PIF score). Pulmonary function was related to the Hunt and Hess (H & H) grade assigned to the patient at hospital admission (p < 0.001). The pattern and time course of lung injury differed significantly between patients with H & H Grade I or II, Grade III, and Grade IV or V. Hunt and Hess grade, Fisher computerized tomography grade, intracranial pressure, cerebral perfusion pressure, LIS, ratio of PaO2 to the fraction of inspired oxygen (FiO2), and the ratio of the alveolar-minus-arterial oxygen tension difference (AaDO2) to FiO2 were related to neurological outcome (p < 0.001). The LIS on the day of maximum lung injury remained an independent predictor of outcome (p = 0.01) in a stepwise logistic regression analysis. The probability of poor neurological outcome significantly increased with both decreasing cerebral perfusion pressure and increasing severity of lung injury.
The overall mortality rate was 22.2% (46 of 207 patients). Subarachnoid hemorrhage and its neurological sequelae accounted for the principal mortality in this series. Medical (nonneurological and nontreatment-related) complications accounted for 37% of all deaths. Systemic inflammatory response syndrome with associated multiple organ dysfunction syndrome was the leading cause of death from medical complications. The authors conclude that respiratory failure is related to neurological outcome, although it is not commonly the primary cause of death from medical complications.
本观察性研究基于207例动脉瘤性蛛网膜下腔出血患者的连续系列病例，这些患者在最近一次出血后7天内接受了治疗。本研究的目的是评估呼吸衰竭对神经功能转归的影响。
通过测定描述肺氧运输和交换的参数、使用肺损伤综合评分（肺损伤评分[LIS]）和机械通气设置（PIF评分）来评估肺功能。肺功能与患者入院时的Hunt和Hess（H&H）分级相关（p<0.001）。H&H分级为I或II级、III级以及IV或V级的患者之间，肺损伤的模式和时间进程存在显著差异。Hunt和Hess分级、Fisher计算机断层扫描分级、颅内压、脑灌注压、LIS、动脉血氧分压与吸入氧分数（FiO2）之比以及肺泡-动脉氧分压差（AaDO2）与FiO2之比均与神经功能转归相关（p<0.001）。在逐步逻辑回归分析中，肺损伤最严重那天的LIS仍然是转归的独立预测因素（p=0.01）。神经功能转归不良的概率随着脑灌注压降低和肺损伤严重程度增加而显著升高。
总死亡率为22.2%（207例患者中的46例）。蛛网膜下腔出血及其神经后遗症是本系列病例中的主要死亡原因。医疗（非神经和非治疗相关）并发症占所有死亡的37%。伴有相关多器官功能障碍综合征的全身炎症反应综合征是医疗并发症死亡的主要原因。作者得出结论，呼吸衰竭与神经功能转归相关，尽管它通常不是医疗并发症的主要死亡原因。
