低度瘤下arachnoid 出血后的结果:一个前性观察性研究
Jack Henry1,2, Mohammed O Dablouk3,4, Dhruv Kapoor3
1National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland. jackhenry22@rcsi.ie.
Acta neurochirurgica
|November 15, 2023
概括
低度动脉瘤下arachnoid出血 (aSAH) 的结果仍然令人丧,特别是世界神经外科协会 (WFNS) 的IV和V等级. 然而,为动脉瘤固定治疗的选定患者显示出50%以上的良好结果,年龄和血管是关键因素.
科学领域:
- 神经外科 神经外科
- 神经学 神经学
- 关键护理医学 关键护理医学
背景情况:
- 动脉瘤下关节出血 (aSAH) 经常表现为低等级 (WFNS IV-V),影响患者的治疗结果.
- 了解这些严重病例的功能结果和预后因素对于临床管理至关重要.
研究的目的:
- 为了评估低度aSAH患者的功能结果.
- 为了确定影响aSAH患者结果的预后因素.
- 评估动脉瘤固定在改善结果的有效性.
主要方法:
- 对低等级的aSAH患者进行前性研究,将其转移到国家神经外科服务 (2016-2019).
- 多变量逻辑回归用于预测功能不良的结果 (3个月的GOS1-3).
- 分析包括患者人口统计,临床表现,治疗细节和预后因素.
主要成果:
- 45.1%的转诊患者接受了动脉瘤治疗,大多是在48小时内.
- 在所有转诊患者中,73.5%的患者出现了不良结果.
- 没有反应的瞳孔和循环停止表明普遍的预后不佳;WFNS V具有比WFNS IV更高的不良结果风险. 在接受治疗的患者中,年龄,再出血,血管和CSF转移是显著的预后因素.
结论:
- 由于出血的严重程度,WFNS IV和V aSAH的总体结果仍然很差.
- 动脉瘤固定可以在超过一半的选定患者中带来良好的结果.
- 关键的预后因素包括年龄,干预前再出血,血管,以及CSF转移.
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