当小动脉瘤出血时:功能性结果和基于大小的风险分层的局限性
Cyrus Raki1, Lily Davies1, Leon Lai2
1School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; Department of Neurosurgery, Monash Health, Level 5, Block D, 246 Clayton Road, Clayton, Victoria 3168, Australia.
概括
破裂的小脑动脉瘤 (<5毫米) 会导致与较大的动脉瘤一样严重的结果,这挑战了他们认为的较低的临床意义. 动脉瘤大小本身并不能预测下大脑底下出血后的功能结果.
科学领域:
- 神经外科 神经外科
- 神经学 神经学
- 血管医学 血管医学
背景情况:
- 小型内动脉瘤 (≤5毫米) 在临床意义上往往被低估.
- 虽然研究了破裂风险,但破裂后发病率的严重程度尚不清楚.
- 这项研究调查了动脉瘤大小作为后动脉瘤下关节出血 (aSAH) 后功能结果的预测因素.
研究的目的:
- 为了确定内动脉瘤的大小是否独立地预测下大脑下出血后的功能结果.
- 为了评估患有小动脉瘤与大动脉瘤的患者的破裂后发病率.
- 为了识别aSAH后功能不良结果的独立预测因素.
主要方法:
- 追溯的队列研究,对421名患有破裂的囊内动脉瘤的患者进行了追溯的队列研究.
- 动脉瘤以直径分层: ≤5mm与>5mm相比.
- 主要结局:90天后的功能依赖 (修改的兰金尺度>2);使用多变量逻辑回归.
主要成果:
- 42.3%的破裂动脉瘤是≤5毫米.
- 较大的动脉瘤 (>5毫米) 显示出更糟糕的放电功能状态,但90天的结果相似 (40.3%与35.4%,P=0.303).
- 动脉瘤大小不是90天功能表现不佳的独立预测因素 (P=0.304).
结论:
- 破裂的小动脉瘤 (<5毫米) 的临床结果与较大的动脉瘤相美.
- 这些发现挑战了小破裂动脉瘤在临床上意义较小的观念.
- 动脉瘤大小本身是不够的风险分层和结果预测后aSAH.
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