Global cerebral edema after subarachnoid hemorrhage - Frequency, predictors, and impact on outcome
Global cerebral edema after subarachnoid hemorrhage - Frequency, predictors, and impact on outcome
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DOI：
10.1161/01.str.0000015624.29071.1f
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发表时间：
2002-05-01
期刊：
影响因子：
8.3
通讯作者：
Mayer, SA
中科院分区：
文献类型：
--
作者：
Claassen, J;Carhuapoma, JR;Mayer, SA
背景和目的：蛛网膜下腔出血（SAH）后CT显示的脑水肿很常见。炎症或循环机制已被假定为解释SAH后的放射学观察结果。我们试图确定的频率，原因和影响的结果，早期和迟发性全球性脑水肿后SAH. Methods，我们评估了存在的全球性水肿的入院和后续的CT扫描在374 SAH患者入院后5天内发病，我们的神经重症监护室之间的1996年7月和2001年2月。使用多变量分析，我们确定了全球性脑水肿的预测因素，并评估了全球性水肿的影响，对结果3个月后发病与修改后的兰金Scale.Results-Global水肿是目前在入院CT扫描的8%（n=29）和发展继发于12%（n=44）的患者。入院时全身水肿可通过发作时意识丧失和Hunt-Hess分级增加来预测。动脉瘤大小> 10 mm、发作时意识丧失、使用血管加压药和SAH总分增加可预测迟发性全身水肿。37%（n=137）的患者在3个月时死亡或严重残疾（改良兰金量表4至6）。死亡或严重残疾的预测任何全球性水肿，动脉瘤大小> 10毫米，在发作时意识丧失，增加国立卫生研究院卒中量表评分，和老年aging. Conclusions全球性水肿是一个独立的危险因素，死亡率和预后不良后SAH。意识丧失可能反映了发作性脑循环停止，是入院时全身水肿的危险因素，而血管加压药诱导的高血压与迟发性全身水肿的发生有关。最大限度地减少SAH后水肿形成的重症监护管理策略可能会改善预后。
Background and Purpose-Cerebral edema visualized by CT is often seen after subarachnoid hemorrhage (SAH). Inflammatory or circulatory mechanisms have been postulated to explain this radiographic observation after SAH. We sought to determine the frequency, causes, and impact on outcome of early and delayed global cerebral edema after SAH.Methods-We evaluated the presence of global edema on admission and follow-up CT scans in 374 SAH patients admitted within 5 days of onset to our Neurological Intensive Care Unit between July 1996 and February 2001. Using multivariate analysis, we identified predictors of global cerebral edema and evaluated the impact of global edema on outcome 3 months after onset with the modified Rankin Scale.Results-Global edema was present on admission CT scans in 8% (n=29) and developed secondarily in 12% (n=44) of the patients. Global edema on admission was predicted by loss of consciousness at ictus and increasing Hunt-Hess grade. Delayed global edema was predicted by aneurysm size > 10 mm, loss of consciousness at ictus, use of vasopressors, and increased SAH sum scores. Thirty-seven percent (n=137) of the patients were dead or severely disabled (modified Rankin Scale 4 to 6) at 3 months. Death or severe disability was predicted by any global edema, aneurysm size > 10 mm. loss of consciousness at ictus, increased National Institutes of Health Stroke Scale scores, and older age.Conclusions-Global edema is an independent risk factor for mortality and poor outcome after SAH. Loss of consciousness, which may reflect ictal cerebral circulatory arrest, is a risk factor for admission global edema, and vasopressor-induced hypertension is associated with the development of delayed global edema. Critical care management strategies that minimize edema formation after SAH may improve outcome.