FACTORS AFFECTING OUTCOME AFTER SURGERY FOR INTRACRANIAL ANEURYSM IN GLASGOW
FACTORS AFFECTING OUTCOME AFTER SURGERY FOR INTRACRANIAL ANEURYSM IN GLASGOW
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DOI：
10.3109/02688699109002882
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发表时间：
1991-01-01
影响因子：
1.1
通讯作者：
BULLOCK, R
中科院分区：
文献类型：
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作者：
TAYLOR, B;HARRIES, P;BULLOCK, R
295例血管造影证实的颅内动脉瘤患者在3年内（1986-88）被送到格拉斯哥神经科学研究所。我们对这一组进行了审查，以评估管理模式的变化对结果的影响。总死亡率为9.4%，手术死亡率为4%。与不良结局显著相关的因素包括：入院时WFNS III-V级、首次CT扫描时存在血肿、迟发性缺血性功能障碍和术后血肿的发展。与以前的研究相比，76%的迟发性缺血性功能障碍患者（近三分之一的近期蛛网膜下腔出血患者）恢复良好，超过三分之二的IV级和V级患者（28例患者）在手术后恢复良好。IV级和V级患者以及迟发性缺血患者的积极治疗，以及预防性尼莫地平治疗和选择性早期手术，为进一步改善蛛网膜下腔出血后的结局提供了最佳前景。
Two-hundred and ninety-five patients with angiographically demonstrated intracranial aneurysms presented to the Institute of Neurological Sciences, Glasgow over a 3-year period (1986-88). We have reviewed this group to assess the effect of changing patterns of management upon outcome. The overall mortality rate was 9.4%, and the surgical mortality rate was 4% in this selected series. Factors significantly associated with a poor outcome were: WFNS grades III-V on admission, presence of a haematoma on the first CT scan, delayed ischaemic deficit, and development of a post-operative haematoma. Seventy-six per cent of the patients who developed a delayed ischaemic deficit (nearly a third of those with recent subarachnoid haemorrhage) made a good recovery, in contrast to previous studies, and over two-thirds of those accepted in grades IV and V (28 patients) made a good recovery after surgery. Active management of patients in grades IV and V, and those with delayed ischaemia, together with prophylactic Nimodipine therapy and selective early surgery, offers the best prospect for further improvement in outcome after aneurysmal subarachnoid haemorrhage.