Specialized neurocritical care, severity grade, and outcome of patients with aneurysmal subarachnoid hemorrhage
Specialized neurocritical care, severity grade, and outcome of patients with aneurysmal subarachnoid hemorrhage
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DOI：
10.1385/ncc:5:2:85
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发表时间：
2006-01-01
影响因子：
3.5
通讯作者：
Keller, Emanuela
中科院分区：
文献类型：
--
作者：
Lerch, Corinne;Yonekawa, Yasuhiro;Keller, Emanuela
前言：为了评估专门的神经危重护理对住进神经血管中心的人群和严重动脉瘤性蛛网膜下腔出血(ASAH)患者预后的影响。方法：排除1999-2003年间接受血管内技术治疗的患者后，对198例ASAH患者进行早期动脉瘤夹闭治疗。1999年，苏黎世大学医院神经外科建立了一项新的重症监护治疗标准化方案。结果：198例ASAH患者中，轻度ASAH 1级90例(45.5%)，3级41例(27.3%)，4级36例(18.2%)，5级57例(28.8%)。47.0%)与引入早期手术后的前一时期相比(15.3%；23/150150；p<；0.0001)。早期WFNS分级为4级的23例患者中有10例(43.5%)恢复良好，格拉斯哥预后评分为4分和5分；而在后一系列中，WFNS分级为4级的36例患者中有23例(63.9%)功能状态良好。1999年前，WFNS 5级患者全部死亡或存活于植物状态。从1999年到2003年，57例ASAH WFNS 5级患者中有20例(35.1%)存活下来，预后良好。结论：扩展的专科神经危重护理的可获得性似乎促使患者群体向更高的严重程度转变。高度ASAH患者可能从高度专业化的神经危重护理治疗中受益最大。
Introduction: To evaluate the impact of specialized neurocritical care on the population admitted to a neurovascular center and on the outcome of patients with severe aneurysmal subarachnoid hemorrhage (aSAH).Methods: After exclusion of patients treated with endovascular techniques, between 1999 and 2003, 198 patients with aSAH treated with early aneurysm clipping were analysed. In 1999, a new standardized protocol for intensive care treatment was established in the Department of Neurosurgery, University Hospital Zurich. The results were compared to the earlier time period (1993-1994) immediately after introduction of early aneurysm clipping.Results: Out of 198 patients with aSAH, 90 patients (45.5%) suffered from mild aSAH World Federation of Neurosurgical Societies (WFNS) grade 1 and 2,41 (27.3%) from aSAH WFNS grade 3, 36 (18.2%) from grade 4, and 57 (28.8%) from grade 5. From 1999 to 2003, significantly more patients with severe aSAH WFNS grade 4 and 5 underwent (further) treatment (93 out of 198 patients; 47.0%) compared to the former time-period after introduction of early surgery (23 out of 150 patients; 15.3%) (p < 0.0001). In the early series, 10 out of 23 patients (43.5%) with WFNS 4 recovered with good outcome Glasgow Outcome Score 4 and 5, whereas in the later series 23 out of 36 (63.9%) with WFNS grade 4 survived in a good functional state. Before 1999, all patients with WFNS grade 5 died or survived in a vegetative state. From 1999 to 2003, 20 out of 57 patients (35.1%) with aSAH WFNS grade 5 survived with good outcome.Conclusions: The availability of extended specialized neurocritical care seems to induce a change within the patient population towards a higher severity grade. Patients with high-grade aSAH might benefit most from highly specialized neurocritical care treatment.