Clinical Presentation to the Emergency Department Predicts Subarachnoid Hemorrhage-Associated Myocardial Injury.
Clinical Presentation to the Emergency Department Predicts Subarachnoid Hemorrhage-Associated Myocardial Injury.
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DOI：
10.1016/j.jen.2017.06.005
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发表时间：
2018-03
影响因子：
1.7
通讯作者：
Hravnak M
中科院分区：
文献类型：
--
作者：
Yousef KM;Crago E;Lagattuta TF;Hravnak M
动脉瘤性蛛网膜下腔出血常见于急诊室。蛛网膜下腔出血相关心肌损伤 (SAHMI) 等继发性损伤影响三分之一的幸存者，并导致不良预后。 SAHMI 并非由心肌疾病引起的缺血引起，但可导致低血压和心律失常。急诊护士必须认识到哪些临床表现特征可以预测 SAHMI，以便采取适当的干预措施。本研究的目的是确定急诊科 aSAH 患者的临床表现是否可以预测 SAHMI（定义为肌钙蛋白 I ≥0.3ng/ml）。这是一项前瞻性描述性研究。 SAHMI 定义为肌钙蛋白 I ≥0.3ng/ml。预测因素包括：人口统计和临床特征、损伤严重程度、入院 12 导联心电图、急诊室初始生命体征以及动脉瘤破裂时的院前症状。 449 名患者中，126 名 (28%) 患有 SAHMI。 SAHMI 患者更有可能报告癫痫发作和反应迟钝，格拉斯哥昏迷评分显着较低，Hunt 和 Hess 3-5 级以及 Fisher III 和 IV 级比例较高（全部 p <.05）。 SAHMI 患者的心房率和心室率较高，初始心电图 QTc 间期较长 (p <.05)。在多变量逻辑回归中，较差的 Hunt 和 Hess 分级、院前无反应报告、较低的入院格拉斯哥昏迷评分和较长的 QTc 间期是 SAHMI 的显着且独立的预测因素 (p<.05)。急诊科蛛网膜下腔出血临床表现的组成部分可预测 SAHMI。识别急诊科的 SAHMI 患者有助于确定监测和护理需求，并通知转院护理。
Aneurysmal subarachnoid hemorrhage is frequently seen in emergency departments. Secondary injury such as subarachnoid hemorrhage-associated myocardial injury (SAHMI) affects one-third of survivors and contributes to poor outcomes. SAHMI is not attributed to ischemia from myocardial disease but can result in hypotension and arrhythmias. It is important that emergency nurses recognize which clinical presentation characteristics are predictive of SAHMI to initiate proper interventions. The aim of this study was to determine whether clinical presentation of aSAH patients to the emergency department predict SAHMI as defined by troponin I ≥0.3ng/ml. This was a prospective descriptive study. SAHMI was defined as troponin I ≥0.3ng/ml. Predictors included: demographics and clinical characteristics, injury severity, admission 12-lead ECG, initial emergency department vital signs, and pre-hospital symptoms at time of aneurysm rupture. Of 449 patients, 126 (28%) had SAHMI. Patients with SAHMI were more likely to report seizures and unresponsiveness, with significantly lower Glasgow coma score, and higher proportion of Hunt and Hess grades 3-5 and Fisher grades III and IV (all p <.05). SAHMI patients had higher atrial and ventricular rates and longer QTc interval on initial ECG (p <.05). On multivariable logistic regression, poor Hunt and Hess grade, report of prehospital unresponsiveness, lower admission Glasgow coma score, and longer QTc interval were significantly and independently predictive of SAHMI (p<.05). Components of the clinical presentation of subarachnoid hemorrhage to the emergency department predict SAHMI. Identifying SAHMI patients in the emergency department can be helpful in determining surveillance and care needs, and informing transfer unit care.
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影响因子：
3.5
作者：
Frangiskakis, J. Michael;Hravnak, Marilyn;Crago, Elizabeth A.;Tanabe, Masaki;Kip, Kevin E.;Gorcsan, John, III;Horowitz, Michael B.;Kassam, Amin B.;London, Barry
通讯作者：
London, Barry
影响因子：
8.3
作者：
Hravnak M;Frangiskakis JM;Crago EA;Chang Y;Tanabe M;Gorcsan J 3rd;Horowitz MB
通讯作者：
Horowitz MB
DOI：
10.1186/s13054-014-0558-1
发表时间：
2014-10-30
期刊：
Critical care (London, England)
影响因子：
--
作者：
Salem R;Vallée F;Dépret F;Callebert J;Maurice JP;Marty P;Matéo J;Madadaki C;Houdart E;Bresson D;Froelich S;Stapf C;Payen D;Mebazaa A
通讯作者：
Mebazaa A
影响因子：
4.8
作者：
van der Bilt, Ivo A.;Hasan, Djo;Wilde, Arthur A.
通讯作者：
Wilde, Arthur A.
影响因子：
1.6
作者：
Jeon, Ik-Chan;Chang, Chul-Hoon;Kim, Seong-Ho
通讯作者：
Kim, Seong-Ho