Early vasospasm on admission angiography in patients with aneurysmal subarachnoid hemorrhage is a predictor for in-hospital complications and poor outcome
Early vasospasm on admission angiography in patients with aneurysmal subarachnoid hemorrhage is a predictor for in-hospital complications and poor outcome
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DOI：
10.1161/01.str.0000144654.79393.cf
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发表时间：
2004-11-01
期刊：
影响因子：
8.3
通讯作者：
Rosengart, AJ
中科院分区：
文献类型：
--
作者：
Baldwin, ME;Macdonald, RL;Rosengart, AJ
背景和目的-早期血管痉挛 (EVSP) 定义为动脉瘤破裂后 48 小时内诊断性血管造影所见的动脉狭窄，是蛛网膜下腔出血 (SAH) 患者中一种很少报道且定义不明确的现象。本研究的目的是在此类患者的大型数据库中描述 EVSP 的特征。方法 - 我们分析了 1991 年至 1997 年间在世界各地的神经外科中心进行的 4 项前瞻性、随机、双盲、安慰剂对照替拉扎德试验中的 3478 名患者的 EVSP 与临床特征、院内并发症和 3 个月结果的关系。结果 - 339 (10%) 3478 名患者患有 EVSP。入院时神经系统分级较差、有 SAH 病史、脑内血肿、较大动脉瘤、颅脑计算机断层扫描显示较厚 SAH 和脑室内出血的患者发生 EVSP 的可能性明显更高。 EVSP 与迟发性脑血管痉挛无关。调整入院特征差异后，EVSP 与脑梗塞（调整后比值比 [OR]=1.51；95% CI，1.18 至 1.94；P=0.001）、神经功能恶化（OR=1.41；95% CI，1.10 至 1.81；P=0.007）和不良结局相关（OR=1.51；95%） CI，1.15 至 2.00；P=0.003）。此外，EVSP 日益严重的患者有出现不良结局的趋势（轻度 EVSP 的 OR=1.84，中度/重度 EVSP 的 OR=2.66）。结论：EVSP 见于 10% 的 SAH 患者，可预测脑梗死和神经功能恶化以及 3 个月时的不良结局。 EVSP 与晚期血管痉挛无关。 EVSP 在预测 SAH 患者的并发症和长期发病率方面可能与迟发性血管痉挛一样重要。
Background and Purpose-Early vasospasm (EVSP), defined here as arterial narrowing seen on diagnostic angiography within the first 48 hours of aneurysmal rupture, is a rarely reported and poorly defined phenomenon in patients with subarachnoid hemorrhage (SAH). The purpose of this study was to characterize EVSP in a large database of such patients.Methods-We analyzed the relationship of EVSP to clinical characteristics, in-hospital complications, and outcome at 3 months among 3478 patients entered into 4 prospective, randomized, double-blind, placebo-controlled trials of tirilazad conducted in neurosurgical centers around the world between 1991 and 1997.Results-Three hundred thirty-nine (10%) of 3478 patients had EVSP. EVSP was significantly more likely in patients with poor neurological grade on admission, history of SAH, intracerebral hematoma, larger aneurysm, thick SAH on cranial computed tomography, and intraventricular hemorrhage. EVSP was not associated with delayed cerebral vasospasm. After adjustment for differences in admission characteristics, EVSP was associated with cerebral infarction (adjusted odds ratios [OR]=1.51; 95% CI, 1.18 to 1.94; P=0.001), neurological worsening (OR=1.41; 95% CI, 1.10 to 1.81; P=0.007), and unfavorable outcome (OR=1.51; 95% CI, 1.15 to 2.00; P=0.003). In addition, there was a trend for patients with increasingly severe EVSP to have unfavorable outcome (OR=1.84 for mild and OR=2.66 for moderate/severe EVSP).Conclusions-EVSP was seen in 10% of SAH patients and was predictive of cerebral infarction and neurological worsening as well as unfavorable outcome at 3 months. EVSP was not associated with late vasospasm. EVSP may be as important as delayed vasospasm in predicting complications and long-term morbidity in SAH patients.