Abstract
Abstract To explore the critical care treatment and clinical outcome of patients with severe aneurysmal subarachnoid hemorrhage (SaSAH), and to provide clinical evidence for the treatment of patients with SaSAH. 160 patients with SaSAH of Hunt and Hess (H&H) grade III or above in the neurosurgical critical care unit at ourospital between June 2016 and June 2018 were enrolled in this study. Patients were treated with brain protective bundle based on step-wised protocol under multimodal monitoring and followed up for 3 months. The incidence of various clinical complications and the clinical prognosis after discharge were statistically analyzed. Furthermore, it carried on the correlation analysis to the risk factors and the prognosis. In 160 patients with SaSAH, 127 patients had responsible aneurysms located in the anterior circulation, and the other 33 patients were located in the posterior circulation. 70 patients (43.8%) underwent transcranial clipping, 81 patients (50.6%) underwent endovascular embolization and 9 patients (5.6%) did not intervene. Patients with IV and V grades of Glasgow Outcome Scale (GOS) were considered good recovery, and those with grade I, II and III were poor prognosis. The 30-day good prognosis rate was 41.3% (66/160) and the poor prognosis rate was 58.7% (94/160). Multivariate logistic regression analysis showed that the Hunt & Hess classification correlated well with prognosis (OR: 4.367,95% CI, 2.254-8.460, P < 0.001). The clinical prognosis of patients with SaSAH is still poor. In particular, under the critical care of neurosurgery, the application of brain protective bundle based on step-wised protocol under multimodal monitoring might improve the clinical prognosis of patients with SaSAH.
Highlights
Aneurysmal subarachnoid hemorrhage is a common clinical disease with an annual incidence of about 1/10000 (Steiner et al, 2013)
Practical Application: Our results suggested that under the critical care of neurosurgery, the application of brain protective bundle based on step-wised protocol under multimodal monitoring might improve the clinical prognosis of patients with severe aneurysmal subarachnoid hemorrhage (SaSAH)
(2) The patient was diagnosed as SAH by brain computed tomography (CT) and confirmed as aSAH by digital subtraction angiography (DSA) or computed tomography angiography (CTA). (3) Clinical evaluation of Received 13 Aug., 2020 Accepted 15 Sept., 2020 1Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
Summary
Aneurysmal subarachnoid hemorrhage (aSAH) is a common clinical disease with an annual incidence of about 1/10000 (Steiner et al, 2013). The clinical outcomes of patients depend on a variety of factors, including the severity of acute bleeding, the initial condition of the patient, the presence of early rebleeding, and the presence or absence of delayed cerebral ischemia (DCI) (Kundra et al, 2014). Studies have shown that prognosis is associated with poor clinical performance and delayed cerebral ischemia. Sejkorová et al (2016) considered an initially high Hunt and Hess (H&H) grade Hunt & Hess, 1968) as an unfavorable factor for the clinical outcome of patients with ruptured aneurysms of the posterior inferior cerebellar artery after interdisciplinary treatment Studies have shown that prognosis is associated with poor clinical performance and delayed cerebral ischemia. Sejkorová et al (2016) considered an initially high Hunt and Hess (H&H) grade Hunt & Hess, 1968) as an unfavorable factor for the clinical outcome of patients with ruptured aneurysms of the posterior inferior cerebellar artery after interdisciplinary treatment
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