动脉瘤性蛛网膜下腔出血后脑梗死的预测
Title：Predictors of cerebral infarction in patients with aneurysmal subarachnoidhemorrhage.
Author： Fergusen S, Macdonald RL.
Resource: Neurosurgery. 2007 Apr;60(4):658-67; discussion 667.
Abstract：OBJECTIVE: Cerebral infarction would be expected to be associated with poor outcome after aneurysmal subarachnoid hemorrhage (SAH), although there are few data on which to base this assumption. The goals of this study were to determine
the impact of cerebral infarction on outcome and to examine predictors of
infarction in these patients. METHODS: Univariate and multivariable statistical
methods were used to examine the impact of cerebral infarction on the Glasgow
Outcome Scale score 3 months after SAH among 3567 patients entered into four
prospective, randomized, double-blind, placebo-controlled trials of tirilazad
conducted in neurosurgical centers around the world between 1991 and 1997.
Patient demographics, clinical variables, radiographic characteristics, and
treatment variables associated with cerebral infarction were also determined by
the same methods. RESULTS: Seven hundred and seven (26%) out of 2741 patients
with complete data had cerebral infarction on computed tomographic scans 6 weeks
after SAH. Multivariable logistic regression showed that cerebral infarction
increased the odds of unfavorable outcome by a factor of 5.4 (adjusted odds
ratio, 5.4; 95% confidence interval, 4.2-6.8; P < 0.0001), which was a higher
odds ratio than all other factors associated with outcome. The proportion of
explained variance in outcome was also highest for cerebral infarction and
accounted for 39% of the explained variance. Multivariable analysis found that
cerebral infarction was significantly associated with increasing patient age,
worse neurological grade on admission, history of hypertension or diabetes
mellitus, larger aneurysm, use of prophylactically or therapeutically induced
hypertension, temperature more than 38 degrees C 8 days after SAH, and
symptomatic vasospasm. CONCLUSION: Cerebral infarction was strongly associated
with poor outcome after aneurysmal SAH. The most important potentially treatable
factor associated with infarction was symptomatic vasospasm.
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