Response of Brain Oxygen to Therapy Correlates with Long-Term Outcome After Subarachnoid Hemorrhage
Response of Brain Oxygen to Therapy Correlates with Long-Term Outcome After Subarachnoid Hemorrhage
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DOI：
10.1007/s12028-013-9890-6
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发表时间：
2013-12-01
影响因子：
3.5
通讯作者：
Levine, Joshua M.
中科院分区：
文献类型：
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作者：
Bohman, Leif-Erik;Pisapia, Jared M.;Levine, Joshua M.
脑氧（PbtO 2）监测可以帮助指导对低级别蛛网膜下腔出血（aSAH）患者的护理。PbtO 2导向治疗与长期结局之间的关系尚不清楚。我们假设对PbtO 2定向干预的反应性与结果相关。纳入了76例接受PbtO 2监测的aSAH患者。长期结果[格拉斯哥结果评分扩展（GOS-E）和改良兰金量表（mRS）]使用社会保障死亡数据库和结构化电话访谈确定。采用单因素和多因素回归分析确定与预后相关的变量，分析了64例患者的数据（12例失访）。在总计7，174小时的监测时间内，有530次PbtO 2受损（< 20 mmHg）事件，接受了1，052次干预治疗。42例患者（66%）存活出院。中位随访时间为8.5个月（范围0.1-87）。在最近的随访中，35例（55%）患者存活，28例（44%）结局良好（mRS为千分之一货币符号3）。在多元有序回归分析中，只有年龄和PbtO 2定向干预的反应与结果显著相关。年龄增加与预后不良相关（coeff. 0.8，95% CI 0.3-1.3，p = 0.003），对PbtO 2定向干预的反应与结局改善相关（coeff. -2.12，95%CI-4.0至-0.26，p = 0.03）。结果良好的患者对PbtO 2定向干预的平均应答率为70%，而结果较差的患者的应答率为45%（p = 0.005）。对PbtO 2定向干预的应答与aSAH患者长期功能结局的改善相关。
Brain oxygen (PbtO2) monitoring can help guide care of poor-grade aneurysmal subarachnoid hemorrhage (aSAH) patients. The relationship between PbtO2-directed therapy and long-term outcome is unclear. We hypothesized that responsiveness to PbtO2-directed interventions is associated with outcome.Seventy-six aSAH patients who underwent PbtO2 monitoring were included. Long-term outcome [Glasgow Outcome Score-Extended (GOS-E) and modified Rankin Scale (mRS)] was ascertained using the social security death database and structured telephone interviews. Univariate and multivariate regression were used to identify variables that correlated with outcome.Data from 64 patients were analyzed (12 were lost to follow-up). There were 530 episodes of compromised PbtO2 (< 20 mmHg) during a total of 7,174 h of monitor time treated with 1,052 interventions. Forty-two patients (66 %) survived to discharge. Median follow-up was 8.5 months (range 0.1-87). At most recent follow-up 35 (55 %) patients were alive, and 28 (44 %) had a favorable outcome (mRS a parts per thousand currency sign3). In multivariate ordinal regression analysis, only age and response to PbtO2-directed intervention correlated significantly with outcome. Increased age was associated with worse outcome (coeff. 0.8, 95 % CI 0.3-1.3, p = 0.003), and response to PbtO2-directed intervention was associated with improved outcome (coeff. -2.12, 95 % CI -4.0 to -0.26, p = 0.03). Patients with favorable outcomes had a 70 % mean rate of response to PbtO2-directed interventions whereas patients with poor outcomes had a 45 % response rate (p = 0.005).Response to PbtO2-directed intervention is associated with improved long-term functional outcome in aSAH patients.