Treatment delay from aneurysmal subarachnoid hemorrhage to endovascular treatment: a high-volume hos

来源 :中华神经外科杂志(英文) | 被引量 : 0次 | 上传用户:yanqingilu
下载到本地 , 更方便阅读
声明 : 本文档内容版权归属内容提供方 , 如果您对本文有版权争议 , 可与客服联系进行内容授权或下架
论文部分内容阅读
Background::Early treatment for patients with aneurysmal subarachnoid hemorrhage (aSAH) could significantly reduce the risk of re-bleeding and improve clinical outcomes. We assessed the different time intervals from the initial hemorrhage, admission, and endovascular treatment and identified the risk factors contributing to delay.Methods::Between February 2017 and December 2019, 422 consecutive aSAH patients treated in a high-volume hospital were collected and reviewed. Risk factors contributing to admission delay and treatment delay were analyzed with univariate and multivariate analysis.Results::One hundred twenty-two (28.9%) were admitted to the high-volume hospital at the day of symptom onset and 386 (91.5%) were treated with endovascular management at the same day of admission. The multivariate analysis found that younger age (n P = 0.022, OR = 0.981, 95% CI 0.964-0.997) and good Fisher score (n P = 0.002, OR = 0.420, 95% CI 0.245-0.721) were independent risk factors of admission delay. None was found to be related with treatment delay. Multivariate analysis (OR (95% CI)) showed that higher age 1.027 (1.004-1.050), poorer Fisher score 3.496 (1.993-6.135), larger aneurysmal size 1.112 (1.017-1.216), and shorter interval between onset to admission 1.845 (1.018-3.344) were independent risk factors of poorer clinical outcome.n Conclusion::Treatment delay was mainly caused by pre-hospital delay including delayed admission and delayed transfer. Our experience showed that cerebrovascular team could provide early treatment for aSAH patients. Younger age and good Fisher score were significantly related with admission delay. However, admission delay was further significantly correlated with better clinical outcome.“,”Background::Early treatment for patients with aneurysmal subarachnoid hemorrhage (aSAH) could significantly reduce the risk of re-bleeding and improve clinical outcomes. We assessed the different time intervals from the initial hemorrhage, admission, and endovascular treatment and identified the risk factors contributing to delay.Methods::Between February 2017 and December 2019, 422 consecutive aSAH patients treated in a high-volume hospital were collected and reviewed. Risk factors contributing to admission delay and treatment delay were analyzed with univariate and multivariate analysis.Results::One hundred twenty-two (28.9%) were admitted to the high-volume hospital at the day of symptom onset and 386 (91.5%) were treated with endovascular management at the same day of admission. The multivariate analysis found that younger age (n P = 0.022, OR = 0.981, 95% CI 0.964-0.997) and good Fisher score (n P = 0.002, OR = 0.420, 95% CI 0.245-0.721) were independent risk factors of admission delay. None was found to be related with treatment delay. Multivariate analysis (OR (95% CI)) showed that higher age 1.027 (1.004-1.050), poorer Fisher score 3.496 (1.993-6.135), larger aneurysmal size 1.112 (1.017-1.216), and shorter interval between onset to admission 1.845 (1.018-3.344) were independent risk factors of poorer clinical outcome.n Conclusion::Treatment delay was mainly caused by pre-hospital delay including delayed admission and delayed transfer. Our experience showed that cerebrovascular team could provide early treatment for aSAH patients. Younger age and good Fisher score were significantly related with admission delay. However, admission delay was further significantly correlated with better clinical outcome.
其他文献
焦虑症是最常见的精神障碍疾病,世界卫生组织将焦虑症列为第9大致残原因,其核心症状是过度恐惧和焦虑,并回避自身感知到的持续和有害的威胁[1].焦虑相关中枢核团包括杏仁核、终纹床核、内侧前额叶皮质、海马等,这些中枢核团相互投射构成的神经环路对焦虑症具有重要影响.上述颅内核团与自主神经相关中枢核团存在紧密的关联,干预上述核团可导致自主神经相关中枢核团的活性及外周自主神经活性发生变化.焦虑症患者常合并自主神经功能异常,长期焦虑状态患者面对应激时肌肉交感神经显著激活[2].心脏自主神经失衡可能促进冠心病的进展,因此
心房颤动(AF)是世界上最常见的心律失常,其患病率随着年龄的增长呈指数级增加.AF最大的危害为脑卒中和体循环栓塞,可显著增加病死率及致残率,给社会和患者家庭带来沉重的负担.几十年来,预防非瓣膜性AF患者脑卒中的金标准是维生素K拮抗剂(VKA).安全性更高的新型非维生素K口服抗凝剂最近取代了VKA作为一线治疗选择.然而,由于出血史、大出血风险、医从性差或个人偏好,部分AF患者的高脑卒中风险不适用于长期口服抗凝剂治疗,为AF患者开发替代的脑卒中预防策略迫在眉睫[1].
中国脑卒中的发病率已经超过379/10万,位列世界第一,每年约190万人因脑卒中死亡,脑卒中已经超过肿瘤及冠心病,成为我国居民首位死亡原因[1].脑卒中的高致残率、高病死率和逐年升高的发病率,是影响国计民生的重要公共卫生问题.缺血性脑卒中是脑血管堵塞或血液供应障碍导致的脑功能损害,是最常见的脑卒中类型,占我国脑卒中的69.6%~70.8%[2].脑动脉血栓是缺血性脑卒中的直接病因,血栓的性状能直接影响患者症状及预后;静脉溶栓和血管内治疗是目前缺血性脑卒中最有效的治疗手段,能显著降低缺血性脑卒中患者的病死率
PaCO2变化引起脑血管舒缩是常见生理现象,脑血管反应性指脑内小动脉及毛细血管响应各种刺激而扩张或收缩的能力,反映脑血管储备和调节潜力,临床常用二氧化碳诱发脑血管反应作为衡量指标,即脑血管二氧化碳反应性(CVR-CO2).通过CVR-CO2监测多种疾病或生理因素引起脑血管结构和功能改变,有利于预测缺血性脑卒中、阿尔茨海默病、认知功能障碍等的发生发展,并尽早采取相应预防及治疗措施[1].我们就CVR-CO2监测手段、影响因素及临床意义等加以综述.
目的:探究基因多态性对工人患噪声性听力损失(NIHL)的影响。方法:于2019年5月,采用病例对照研究,选取2017至2018年浙江省5所工厂噪声作业工人,选择双耳高频(3、4、6 kHz)平均听阈>25 dB(A)作为NIHL组,任一耳任一语频(0.5、1、2 kHz)听阈≤25 dB(A)作为非NIHL组,每组307人。收集噪声作业工人的一般人口学资料、职业史、纯音测听结果和口腔拭子黏膜样本,提取口腔黏膜细胞DNA。分析基因风险评分(GRS)与NIHL的关系,对单核苷酸多态性(SNP)进行基因分型,用
目的:探讨n K-ras基因对PMn 2.5染毒人支气管上皮(HBE)细胞部分癌基因和抑癌基因表达的影响。n 方法:于2019年9月,根据n K-ras基因mRNA序列,设计合成干扰序列,转染HBE细胞构建n K-ras基因沉默细胞。用10、50 μg/ml PMn 2.5混悬液及10 μmol/L Crn 6+分别染毒HBE细胞和n K-ras基因沉默细胞,实时荧光定量PCR检测n c-myc、n c-fo
目的:探索导致核医学工作人员甲状腺碘-131(n 131I)内照射的主要危险因素,对工作人员甲状腺n 131I内照射风险进行评估。n 方法:于2019年3至10月,以整群抽样方法收集2018年度福建省开展n 131I核素诊疗的21家核医学单位资料,对n 131I自动分装仪数量、n 131I甲状腺癌(甲癌)和甲状腺功能亢进症(甲亢)及肝癌治疗人数、核医学工作人员数量、执业类别、n 131I操作情况和轮岗情况进行调查,并对其中20家开展n
期刊
Background::Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass surgery is now being widely used in moyamoya disease, and its therapeutic value in SICAO remains divergent.Methods::A systematic search was performed in PubMed, EMBASE, and
Background::Our aim was to evaluate the sensitivity and specificity of the automated computer-based Alberta Stroke Program Early CT Score (e-ASPECTS) for acute stroke patients and compare the result with physicians at different levels.Methods::In our cent