在"内血管第一"治疗之前,经历了动脉瘤下关节出血后重新出血:对已发表的评分系统进行了回顾性病例对照研究
Arosha S Dissanayake1, Emalee Burrows2, Kwok M Ho3
1Department of Neurosurgery, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia arosha.d@gmail.com.
Journal of neurointerventional surgery
|June 14, 2023
概括
在动脉瘤下关节出血 (aSAH) 中治疗前再次出血是风险,即使在早期治疗. 世界神经外科协会联合会 (WFNS) 的评级是与超早期治疗aSAH患者的现有模型相比,再次出血的优越预测指标.
科学领域:
- 神经外科 神经外科
- 神经学 神经学
- 放射学 放射学是一门学科.
背景情况:
- 在治疗前再次出血发生在多达7.2%的动脉瘤下关节出血 (aSAH) 患者中,即使在24小时内进行超早期治疗.
- 评估再次出血的风险对于管理aSAH至关重要,特别是在治疗前的关键时期.
研究的目的:
- 以追溯的方式比较三个已发表的再出血模型和个体预测因子在超早期,内血管首先治疗的aSAH患者中的预测效用.
- 在aSAH中确定最有效的治疗前再出血预测因动脉瘤大小和母血管位置相匹配时.
主要方法:
- 对707名患者的9年队列的回顾性分析,其中有710例aSAH发作.
- 根据动脉瘤大小和母血管位置,与41名对照患者匹配47例治疗前再出血.
- 从人口,临床和放射学数据计算预测得分,然后进行单变量,多变量,AUROCC和KM生存分析.
主要成果:
- 世界神经外科协会联合会 (WFNS) 的评级显示,在多变量建模中,再出血的预测效用最高 (C-统计值为0.740).
- 发表的模型由等人,Oppong等人,和范Lieshout等人. 显示最小至中等的效用 (C统计分别为0.553,0.645和0.53).
- 84%的患者在诊断后14.5小时的中位数使用了内血管治疗.
结论:
- 在超早期治疗的aSAH患者中,WFNS等级是治疗前再出血的优异预测指标,与与动脉瘤特征相匹配的现有模型相比.
- 未来在aSAH中预测再出血的模型应该纳入WFNS等级以提高准确性.
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