Complications and outcome in patients with aneurysmal subarachnoid haemorrhage: a prospective hospital based cohort study in The Netherlands
Complications and outcome in patients with aneurysmal subarachnoid haemorrhage: a prospective hospital based cohort study in The Netherlands
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DOI：
10.1136/jnnp.68.3.337
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发表时间：
2000-03-01
影响因子：
11
通讯作者：
Vermeulen, M
中科院分区：
文献类型：
--
作者：
Roos, YBWEM;de Haan, RJ;Vermeulen, M
目的——本研究的目的是前瞻性地调查一系列未经选择的动脉瘤性蛛网膜下腔出血患者目前的并发症是什么，结果是什么，其中有多少患者接受了“现代治疗”——即早期闭塞动脉瘤和钙拮抗剂治疗——哪些因素导致手术或血管内治疗的延迟，以及改善治疗对结果的估计影响。方法——一项前瞻性、观察性队列研究荷兰特定地区医院内所有动脉瘤性蛛网膜下腔出血患者的比例。记录入院时的情况、诊断程序和治疗。如果患者出现临床恶化，则记录格拉斯哥昏迷评分（GCS）的变化、局灶性神经系统体征的存在、额外检查的结果以及最终诊断的恶化原因。 3 个月随访时使用格拉斯哥结果量表 (GOS) 评估临床结果。在随访时结果不佳的患者中，诊断出原因。结果-在 110 名患者中，47 名 (43%) 的结果不佳。 31 名患者（28%）脑缺血是最常发生的并发症。预后不良的主要原因是初次出血和再出血的影响，分别占 34% 和 30% 的预后不良患者。在所有患者中，102 名（93%）患者接受了钙拮抗剂治疗，45 名患者（41%）接受了早期治疗以消除动脉瘤。延误治疗的主要原因是入院时病情不佳或入院后不久病情恶化，分别占31%和23%。结论：在三分之二预后不良的患者中，预后不良的原因是初次出血的影响，或者是初次出血和再出血的影响。改进延迟性或术后缺血的治疗对蛛网膜下腔出血患者的预后影响很小。
Objective-The aim of this study was to investigate prospectively in an unselected series of patients with an aneurysmal subarachnoid haemorrhage what at present the complications are, what the outcome is, how many of these patients have "modern treatment"-that is, early obliteration of the aneurysm and treatment with calcium antagonists-what factors cause a delay in surgical or endovascular treatment, and what the estimated effect on outcome will be of improved treatment.Methods-A prospective, observational cohort study of all patients with aneurysmal subarachnoid haemorrhage in the hospitals of a specified region in The Netherlands. The condition on admission, diagnostic procedures, and treatments were recorded. If a patient had a clinical deterioration, the change in Glasgow coma score (GCS), the presence of focal neurological signs, the results of additional investigations, and the final diagnosed cause of the deterioration were recorded. Clinical outcome was assessed with the Glasgow outcome scale (GOS) at 3 month follow up. In patients with poor outcome at follow up, the cause was diagnosed.Results-Of the 110 patients, 47 (43%) had a poor outcome. Cerebral ischaemia, 31 patients (28%), was the most often occurring complication. Major causes of poor outcome were the effects of the initial haemorrhage and rebleeding in 34% and 30% of the patients with poor outcome respectively. Of all patients 102 (93%) were treated with calcium antagonists and 45 (41%) patients had early treatment to obliterate the aneurysm. The major causes of delay of treatment were a poor condition on admission or deterioration shortly after admission, in 31% and 23% respectively.Conclusions-In two thirds of the patients with poor outcome the causes of poor outcome are the effects of the initial bleeding the The come are the effects or the initial bleeding and rebleeding. Improved treatment of delayed or postoperative ischaemia will have only minor effects on the outcome of patients with subarachnoid haemorrhage.