Time intervals from subarachnoid hemorrhage to rebleed
Time intervals from subarachnoid hemorrhage to rebleed
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DOI：
10.1007/s00415-014-7365-0
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发表时间：
2014-07-01
影响因子：
6
通讯作者：
Verbaan, D.
中科院分区：
文献类型：
--
作者：
Germans, M. R.;Coert, B. A.;Verbaan, D.
蛛网膜下腔出血（aSAH）后最具威胁性的早期并发症和预后不良的预测因素是再出血。为了评估早期治疗可以预防多大比例的再出血，我们评估了从首次出血到再出血的时间间隔，以及再出血时患者的位置。对2008年至2011年接受治疗的293例患者的患者特征、入院时世界神经外科医生联合会分级和改良兰金量表结局评分、转诊医院和从首次出血到治疗的时间间隔进行了评价。检索再出血的时间间隔和再出血时患者的位置。12%的患者通过CT证实了再出血，另外4%的患者被诊断为可能的再出血。60%的再出血发生在进入治疗中心后。几乎所有的再出血都发生在24小时内，首次出血和再出血之间的中位时间间隔为180分钟。在再出血患者组中，治疗时间明显缩短，死亡率较高。大约六分之一的aSAH患者发生了再出血，其中大多数可能是可以预防的，因为它们发生在进入治疗中心后。通过改善早期动脉瘤治疗的院内后勤，尽快固定动脉瘤，降低再出血率似乎是可行的。一项多中心试验正在探索替代方案，如立即给予抗纤溶药物。
The most threatening early complication and predictor of poor outcome after an aneurysmal subarachnoid hemorrhage (aSAH) is a rebleed. To evaluate what proportion of rebleeds might be prevented by early treatment, we assessed the time interval from the initial hemorrhage to rebleed, and the location of the patient at the time of rebleed. Patient characteristics, World Federation of Neurological Surgeons grade on admission and modified Rankin Scale outcome scores, referring hospitals and time intervals from initial hemorrhage to treatment of 293 patients treated between 2008 and 2011 were evaluated. Time intervals to rebleeds and location of the patients at the time of rebleed were retrieved. Rebleeds were confirmed by CT in 12 % of patients, and an additional 4 % of patients was diagnosed as having a possible rebleed. Sixty percent of rebleeds occurred after admission to the treatment center. Almost all rebleeds occurred within 24 h, with a median time interval between initial hemorrhage and rebleed of 180 min. A significantly shorter time to treatment and a higher mortality were seen in the group of patients with a rebleed. Approximately, one in six patients with an aSAH had a rebleed, of which a majority might have been preventable because they occurred after admission to the treatment center. A reduction in the rebleed rate seems feasible by securing the aneurysm as soon as possible by improving in-hospital logistics for early aneurysm treatment. Alternative options, such as immediate administration of antifibrinolytics, are being explored in a multicenter trial.