The Association Between Spontaneous Hyperventilation, Delayed Cerebral Ischemia, and Poor Neurological Outcome in Patients with Subarachnoid Hemorrhage
The Association Between Spontaneous Hyperventilation, Delayed Cerebral Ischemia, and Poor Neurological Outcome in Patients with Subarachnoid Hemorrhage
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DOI：
10.1007/s12028-015-0138-5
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发表时间：
2015-12-01
影响因子：
3.5
通讯作者：
Rajajee, Venkatakrishna
中科院分区：
文献类型：
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作者：
Williamson, Craig A.;Sheehan, Kyle M.;Rajajee, Venkatakrishna
蛛网膜下腔出血 (SAH) 中自发性过度通气的频率和关联尚不清楚。由于过度换气会减少脑血流量，因此可能会加剧迟发性脑缺血 (DCI) 并恶化神经系统结果。这是对学术医疗中心前瞻性收集的 SAH 患者队列数据的回顾性分析。自发性过度通气的定义是 PaCO2 < 35 mmHg 和 pH > 7.45，并分为中度和重度组。使用chi(2)或t检验比较患有和不患有自发性过度通气的患者的临床和人口统计学特征。采用双变量和多变量逻辑回归分析来检查中度和重度过度换气与 DCI 和出院神经系统结果的关联。在 207 名患者中，113 名 (55%) 患有自发性过度换气。根据 Hunt-Hess、世界神经外科学会联合会 (WFNS) 和 SAH 总评分来衡量，自发性过度换气患者的疾病严重程度更高。他们也更有可能出现以下并发症：肺炎、神经源性心肌损伤、全身炎症反应综合征 (SIRS)、放射线血管痉挛、DCI 和神经系统预后不良。在包括年龄、性别、WFNS、SAH 总评分、肺炎、神经源性心肌损伤、病因和 SIRS 的多变量逻辑回归模型中，仅中度[比值比 (OR) 2.49，95% 置信区间 (CI) 1.10-5.62] 和重度（OR 3.12，95% CI 1.30-7.49）自发性过度通气与 DCI 相关。在多变量 Logistic 回归分析中，严重自发性过度通气（OR 4.52，95% CI 1.37-14.89）也与不良出院结果显着相关。自发性过度通气在 SAH 中很常见，并且与 DCI 和不良神经学结果相关。
The frequency and associations of spontaneous hyperventilation in subarachnoid hemorrhage (SAH) are unknown. Because hyperventilation decreases cerebral blood flow, it may exacerbate delayed cerebral ischemia (DCI) and worsen neurological outcome.This is a retrospective analysis of data from a prospectively collected cohort of SAH patients at an academic medical center. Spontaneous hyperventilation was defined by PaCO2 < 35 mmHg and pH > 7.45 and subdivided into moderate and severe groups. Clinical and demographic characteristics of patients with and without spontaneous hyperventilation were compared using chi (2) or t tests. Bivariate and multivariable logistic regression analyses were conducted to examine the association of moderate and severe hyperventilation with DCI and discharge neurological outcome.Of 207 patients, 113 (55 %) had spontaneous hyperventilation. Spontaneously hyperventilating patients had greater illness severity as measured by the Hunt-Hess, World Federation of Neurosurgical Societies (WFNS), and SAH sum scores. They were also more likely to develop the following complications: pneumonia, neurogenic myocardial injury, systemic inflammatory response syndrome (SIRS), radiographic vasospasm, DCI, and poor neurological outcome. In a multivariable logistic regression model including age, gender, WFNS, SAH sum score, pneumonia, neurogenic myocardial injury, etiology, and SIRS, only moderate [odds ratio (OR) 2.49, 95 % confidence interval (CI) 1.10-5.62] and severe (OR 3.12, 95 % CI 1.30-7.49) spontaneous hyperventilation were associated with DCI. Severe spontaneous hyperventilation (OR 4.52, 95 % CI 1.37-14.89) was also significantly associated with poor discharge outcome in multivariable logistic regression analysis.Spontaneous hyperventilation is common in SAH and is associated with DCI and poor neurological outcome.