在秘鲁的高COVID-19死亡率环境中,大流行病对动脉瘤下关节出血的影响:公共机构的经验
Jose Daniel Flores-Sanchez1, Daniela Alejandra Perez-Chadid2, John Vargas-Urbina1
1Department of Neurosurgery, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru.
Surgical neurology international
|January 12, 2024
概括
在秘鲁,COVID-19大流行导致了动脉瘤下arachnoid出血患者的死亡率增加. 医疗保健资源的重新分配可能影响了关键的非COVID-19疾病的护理.
科学领域:
- 神经学 神经学
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
背景情况:
- "COVID-19"大流行严重破坏了全球医疗保健系统.
- 秘鲁面临着全球最高的COVID-19病例死亡率之一.
- 动脉瘤下关节出血 (SAH) 是一种关键的神经紧急情况.
研究的目的:
- 在秘鲁的COVID-19大流行之前和期间,比较动脉瘤下关节出血 (SAH) 患者的结果.
- 评估与流行病相关的医疗保健变化对SAH患者管理和死亡率的影响.
- 确定与大流行期间死亡率增加相关的因素.
主要方法:
- 对动脉瘤SAH患者进行了回顾性比较研究.
- 两个研究时期:2019年 (大流行前) 和2020年 (大流行第一波).
- 对患者人口统计,并发病,COVID-19状态,临床表现,治疗和结果的分析.
主要成果:
- 分析了114名患者;2019年65名,2020年49名.
- 2020年死亡率较高 (36.7%),与2019年 (15.4%) 相比.
- 2020年观察到增加的并发症 (败血症,呼吸衰竭,急性功能衰竭);COVID-19感染和SAH死亡率之间没有直接联系.
结论:
- 在COVID-19大流行期间,动脉瘤SAH患者面临着更糟糕的结果.
- 潜在的医疗保健资源转移到COVID-19可能会对SAH护理产生负面影响.
- 在流行病期间,为非传染性紧急情况维持基本服务至关重要.
相关概念视频
Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
Aneurysm III: Interprofessional Care
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
Pulmonary Embolism I: Introduction
Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
Hemorrhagic Stroke l: Introduction
A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
Hemorrhagic Stroke ll: Pathophysiology
A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
Increased Intracranial Pressure l: Introduction
Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...


