预后因素在动脉瘤下arachnoid出血与初始临床等级较差的预后因素
Diego Culebras1, Leire Pedrosa2,3, Alejandra Mosteiro1
1Department of Neurosurgery, Hospital Clinic of Barcelona, Barcelona, Spain.
Frontiers in neurology
|April 17, 2025
概括
患有严重动脉瘤下关节出血 (aSAH) 的患者面临着不良预后,老年和血管与更糟糕的结果有关. 多模式监测可以改善这些关键中风病例的功能结果.
科学领域:
- 神经学 神经学
- 神经外科 神经外科
- 脑卒中医学 脑卒中医学
背景情况:
- 动脉瘤下关节出血 (aSAH) 是一种严重的中风类型,患病率和死亡率高,通常影响中年人.
- 尽管早期干预方面取得了进展,但早期脑损伤 (EBI) 和延迟脑缺血 (DCI) 导致患者的治疗结果不佳.
- 预测入院时神经状况不佳的患者的结果仍然具有挑战性.
研究的目的:
- 鉴别与严重aSAH (WFNS 4-5级) 住院患者神经病情不良相关的因素.
- 分析人口统计,临床数据,神经成像和治疗策略对患者预后的影响.
- 为了确定死亡率和功能结果的预测因素,在出院和3个月后续.
主要方法:
- 对377名在2013年至2020年期间入院的aSAH患者 (WFNS 4-5) 的回顾性分析.
- 数据收集包括人口统计,临床严重程度,成像发现,治疗方式和结果 (出院和3个月).
- 进行了统计分析,以确定变量与患者结果之间的相关性.
主要成果:
- 总体死亡率为49%,75岁及以上的患者死亡率为100%.
- 年龄较大和血管学血管 (31%的发病率) 与功能性结果较差有关.
- 多模式监测与出院时更好的功能结果相关,而DCI与新的脑梗塞有很强的相关性.
结论:
- 严重的aSAH患者的预后通常是严峻的,因为他们的入院神经状态不佳.
- 多模式监测和量身定制的治疗方法显示出改善结果的潜在好处.
- 显著的少数 (35%的3个月) 可以实现良好的功能恢复,这应该为预后讨论提供信息.
相关概念视频
Aortic Regurgitation I: Introduction
1.7K
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
1.7K
Aneurysm II: Clinical Manifestations and Diagnostic Studies
593
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...
593
Aneurysm III: Interprofessional Care
479
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...
479
Aneurysm IV: Nursing Management
627
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
627
Hemorrhagic Stroke l: Introduction
41
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...
41
Hemorrhagic Stroke ll: Pathophysiology
57
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...
57


