Defining Vasospasm After Subarachnoid Hemorrhage What Is the Most Clinically Relevant Definition?
Defining Vasospasm After Subarachnoid Hemorrhage What Is the Most Clinically Relevant Definition?
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DOI：
10.1161/strokeaha.108.544700
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发表时间：
2009-06-01
期刊：
影响因子：
8.3
通讯作者：
Mayer, Stephan A.
中科院分区：
文献类型：
--
作者：
Frontera, Jennifer A.;Fernandez, Andres;Mayer, Stephan A.
背景和目的-血管痉挛是蛛网膜下腔出血的一个重要并发症，但在文献中没有明确定义。方法-我们研究了580例蛛网膜下腔出血患者，并确定了这些患者：（1）症状性血管痉挛，定义为排除其他原因后认为继发于血管痉挛的临床恶化;（2）迟发性脑缺血（DCI），定义为症状性血管痉挛，或CT上可归因于血管痉挛的梗死;（3）血管造影痉挛，如数字减影血管造影所见;（4）经颅多普勒（TCD）痉挛，定义为任何平均血流速度>120 cm/sec。进行逻辑回归分析，以检验血管痉挛的每种定义与各种医院并发症和3个月生活质量的关系（疾病影响概况）、认知状态（认知状态电话访谈），工具性日常生活活动（Lawton评分）和3个月时死亡或重度残疾结果：症状性血管痉挛发生率为16%，DCI发生率为21%，血管造影性血管痉挛发生率为31%，TCD痉挛发生率为45%。与症状性痉挛（N = 4）、血管造影痉挛（N = 1）或TCD血管痉挛（N = 1）相比，DCI与更多医院并发症（N = 7;均P < 0.05）相关。血管造影和TCD血管痉挛与临床结局的任何方面均无关。症状性脑血管痉挛和DCI均与工具性日常生活活动能力降低、认知功能障碍和生活质量差有关（均P < 0.05）。然而，只有DCI与死亡或严重残疾在3个月（调整OR，2.2; 95%CI，1.2-3.9; P = 0.007）。结论-DCI是一个更有临床意义的定义，无论是症状恶化单独或存在动脉痉挛血管造影或TCD。（中风。2009; 40：1963-1968.）
Background and Purpose-Vasospasm is an important complication of subarachnoid hemorrhage, but is variably defined in the literature.Methods-We studied 580 patients with subarachnoid hemorrhage and identified those with: (1) symptomatic vasospasm, defined as clinical deterioration deemed secondary to vasospasm after other causes were eliminated; (2) delayed cerebral ischemia (DCI), defined as symptomatic vasospasm, or infarction on CT attributable to vasospasm; (3) angiographic spasm, as seen on digital subtraction angiography; and (4) transcranial Doppler (TCD) spasm, defined as any mean flow velocity >120 cm/sec. Logistic regression analysis was performed to test the association of each definition of vasospasm with various hospital complications, and 3-month quality of life (sickness impact profile), cognitive status (telephone interview of cognitive status), instrumental activities of daily living (Lawton score), and death or severe disability at 3 months (modified Rankin scale score 4-6), after adjustment for covariates.Results-Symptomatic vasospasm occurred in 16%, DCI in 21%, angiographic vasospasm in 31%, and TCD spasm in 45% of patients. DCI was statistically associated with more hospital complications (N = 7; all P < 0.05) than symptomatic spasm (N = 4), angiographic spasm (N = 1), or TCD vasospasm (N = 1). Angiographic and TCD vasospasm were not related to any aspect of clinical outcome. Both symptomatic vasospasm and DCI were related to reduced instrumental activities of daily living, cognitive impairment, and poor quality of life (all P < 0.05). However, only DCI was associated with death or severe disability at 3 months (adjusted OR, 2.2; 95% CI, 1.2-3.9; P = 0.007).Conclusions-DCI is a more clinically meaningful definition than either symptomatic deterioration alone or the presence of arterial spasm by angiography or TCD. (Stroke. 2009; 40: 1963-1968.)