Wartime traumatic cerebral vasospasm: Recent review of combat casualties
Wartime traumatic cerebral vasospasm: Recent review of combat casualties
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DOI：
10.1227/01.neu.0000249190.46033.94
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发表时间：
2006-12-01
期刊：
影响因子：
4.8
通讯作者：
Campbell, William W.
中科院分区：
文献类型：
--
作者：
Armonda, Rocco A.;Bell, Randy S.;Campbell, William W.
目的：爆炸相关的神经损伤与“伊拉克自由行动”（OIF）中最严重的伤亡有关。其后果是脑血管痉挛。本研究评估了所有住院神经外科会诊有关的战斗伤OIF.Methods：从OIF从2003年4月至2005年10月的所有入院的神经创伤和诊断性脑血管造影患者进行评价。有和没有血管痉挛的患者之间的差异和预测vasospam进行了analysed.Results：五十七出119神经外科会诊进行了评价。其中47.4%有冲击伤所致的创伤性血管痉挛。平均痉挛持续时间为14.3天，最长达30天的血管痉挛与假性动脉瘤（P = 0.05）、出血（P = 0.03）、肺叶损伤数量（P = 0.012）和死亡率（P = 0.029）相关。有血管痉挛的患者比无血管痉挛的患者表现更差（p = 0.002）。肺叶损伤的数量和假性动脉瘤的存在是血管痉挛的显著预测因素（P = 0.016和0.02，分别）。对于接受积极开放手术治疗的患者，神经学改善呈显著的二次曲线趋势（P = 0.002）。在vasspam组，微球囊血管成形术显着降低大脑中动脉和基底动脉血流速度（P = 0.046和0.026，分别）。结论：创伤性血管痉挛发生在相当数量的严重神经创伤患者，临床结果是那些与这种条件差。然而，积极的开放手术和血管内治疗策略可能会改善结局。这是第一项分析爆炸相关损伤对脑血管影响的研究。
Objective: Blast related neurotrauma is associated with the severest casualties from Operation Iraq Freedom (OIF). A consequences of this is cerebral vasospasm. This study evaluated all inpatient neurosurgical consults related to battle injury from OIF.Methods: Evaluation of all admissions from OIF from April 2003 to October 2005 was performed on patients with neurotrauma and a diagnostic cerebral angiogram. Differences between patients with and without vasospasm and predictors of vasospam were analyzed.Results: Fifty-seven out of 119 nuerosurgical consults were evaluated. Of these, 47.4% had traumatic vasospasm sustained blast trauma. Average spasm duration was 14.3 days, with a range of up to 30 days vasospasm was associated with the presence of pseudoaneurysm (P = 0.05), hemorrhage (P = 0.03), the number of lobes injured (P = 0.012), and mortality (P = 0.029). Those with vasospasm fared worse than those without (p = 0.002). The number of lobes injured and the presence of pseudoaneurysm were significant predictors of vasospasm (P = 0.016 and 0.02, respectively). There was a significant quadratic trend towards nuerological improvement for those recieving aggressive open surgical treatment (P = 0.002). In the vasospam group, angioplasty with microballoon significantly lowered middle cerebrel artery and basilar blood-flow velocities (P = 0.046 and 0.026, respectively).Conclusion: Traumatic vasospasm occurred in a sustantial number of patients with severe neurotrauma, and clinical outcomes were worse for those with this condition. However, aggressive open surgical and endovascular treatment strategies may have improved outcome. This was the first study to analyze the effects of blast-related injury on the cerebral vasculature.