Neurology:动脉瘤蛛网膜下腔出血患者的短期和长期结局

2020-08-14 MedSci原创 MedSci原创

根据现行指南治疗的aSAH患者短期死亡率为18.4%,5年死亡率为29%。在为期5年的随访中,大多数患者(64.0%)仍然存活且没有残疾。优先进行血管内治疗的患者比神经外科手术的患者具有更好的结局。

近日,神经病学领域权威杂志Neurology上发表了一篇研究文章,该研究旨在描述接受修复治疗的自发性动脉瘤性蛛网膜下腔出血(aSAH)患者短期和5年死亡率以及不良结局。

在这项前瞻性观察性研究中,研究人员在随访3个月、1年和5年对311例aSAH患者的死亡率和不良结局(改良的Rankin量表得分为3-6)进行了分析。根据治疗方式进行敏感性分析。研究人员分析了受试者的住院和5年并发症。

在连续就诊的476例自发性蛛网膜下腔出血患者中,347例患者(72.9%)为aSAH。其中311例(89.6%)患者接受了治疗(242例血管内治疗,69例神经外科手术治疗),受试者平均随访43.4个月(1至145例)。3个月、1年和5年死亡率分别为18.4%、22.9%和29.0%,不良结局发生率分别为42.3%、36.0%和36.0%。调整后的不良结局在血管内治疗后三个月低于神经外科手术治疗,绝对差值为15.8%,在1年时,绝对差值为15.9%。在两组中,需要治疗的人数均为6.3人。血管内治疗的比值比(OR)为0.36 [95%CI为0.18-0.74],神经外科手术治疗为0.40 [95%CI为0.20-0.81]。两种治疗方法之间的并发症无显著差异。然而,采用血管内技术治疗的患者较少进行机械通气(OR=0.67[95%CI为0.54-0.84])。

由此可见,根据现行指南治疗的aSAH患者短期死亡率为18.4%,5年死亡率为29%。在为期5年的随访中,大多数患者(64.0%)仍然存活且没有残疾。优先进行血管内治疗的患者比神经外科手术的患者具有更好的结局。

原始出处:

Jaume Roquer.et al.Short and long-term outcome of aneurysmal subarachnoid hemorrhage patients.Neurology.2020.https://n.neurology.org/content/early/2020/08/13/WNL.0000000000010618

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    2021-02-15 yinhl1978
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    2021-01-04 146615f7m97暂无昵称

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    0

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  5. [GetPortalCommentsPageByObjectIdResponse(id=2001103, encodeId=16be200110326, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Mon Feb 15 19:36:44 CST 2021, time=2021-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1957282, encodeId=6ced195e282e5, content=<a href='/topic/show?id=3c293328175' target=_blank style='color:#2F92EE;'>#动脉瘤蛛网膜下腔出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33281, encryptionId=3c293328175, topicName=动脉瘤蛛网膜下腔出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=198d2500149, createdName=12498bd5m16暂无昵称, createdTime=Mon Jan 18 20:36:44 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913697, encodeId=205a91369e81, content=积分, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=98dc5134227, createdName=146615f7m97暂无昵称, createdTime=Mon Jan 04 20:01:17 CST 2021, time=2021-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1654502, encodeId=de091654502ec, content=<a href='/topic/show?id=5ab788e81d3' target=_blank style='color:#2F92EE;'>#蛛网膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88781, encryptionId=5ab788e81d3, topicName=蛛网膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=396c24497244, createdName=aliceclz, createdTime=Mon Aug 24 15:36:44 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=882197, encodeId=acbb88219e11, content=任务, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=98dc5134227, createdName=146615f7m97暂无昵称, createdTime=Wed Sep 02 15:18:59 CST 2020, time=2020-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809825, encodeId=a8ec809825f3, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200814/81d08245657a4a7f9a1ef713c0ec5878/ec4b201a22194a319b1aeb171bc6bb3d.jpg, createdBy=41e02111625, createdName=1581f8c42cm, createdTime=Mon Aug 17 20:34:17 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1385122, encodeId=228b1385122ce, content=<a href='/topic/show?id=99d99e03311' target=_blank style='color:#2F92EE;'>#长期结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97033, encryptionId=99d99e03311, topicName=长期结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2c31495, createdName=liuyg0228, createdTime=Sun Aug 16 13:36:44 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809099, encodeId=e86e809099ac, content=感谢资料, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=523a1627165, createdName=1dd7ee99m50(暂无匿称), createdTime=Sat Aug 15 09:11:54 CST 2020, time=2020-08-15, status=1, ipAttribution=)]
    2020-09-02 146615f7m97暂无昵称

    任务

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2001103, encodeId=16be200110326, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Mon Feb 15 19:36:44 CST 2021, time=2021-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1957282, encodeId=6ced195e282e5, content=<a href='/topic/show?id=3c293328175' target=_blank style='color:#2F92EE;'>#动脉瘤蛛网膜下腔出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33281, encryptionId=3c293328175, topicName=动脉瘤蛛网膜下腔出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=198d2500149, createdName=12498bd5m16暂无昵称, createdTime=Mon Jan 18 20:36:44 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913697, encodeId=205a91369e81, content=积分, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=98dc5134227, createdName=146615f7m97暂无昵称, createdTime=Mon Jan 04 20:01:17 CST 2021, time=2021-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1654502, encodeId=de091654502ec, content=<a href='/topic/show?id=5ab788e81d3' target=_blank style='color:#2F92EE;'>#蛛网膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88781, encryptionId=5ab788e81d3, topicName=蛛网膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=396c24497244, createdName=aliceclz, createdTime=Mon Aug 24 15:36:44 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=882197, encodeId=acbb88219e11, content=任务, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=98dc5134227, createdName=146615f7m97暂无昵称, createdTime=Wed Sep 02 15:18:59 CST 2020, time=2020-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809825, encodeId=a8ec809825f3, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200814/81d08245657a4a7f9a1ef713c0ec5878/ec4b201a22194a319b1aeb171bc6bb3d.jpg, createdBy=41e02111625, createdName=1581f8c42cm, createdTime=Mon Aug 17 20:34:17 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1385122, encodeId=228b1385122ce, content=<a href='/topic/show?id=99d99e03311' target=_blank style='color:#2F92EE;'>#长期结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97033, encryptionId=99d99e03311, topicName=长期结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2c31495, createdName=liuyg0228, createdTime=Sun Aug 16 13:36:44 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809099, encodeId=e86e809099ac, content=感谢资料, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=523a1627165, createdName=1dd7ee99m50(暂无匿称), createdTime=Sat Aug 15 09:11:54 CST 2020, time=2020-08-15, status=1, ipAttribution=)]
    2020-08-17 1581f8c42cm

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2001103, encodeId=16be200110326, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Mon Feb 15 19:36:44 CST 2021, time=2021-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1957282, encodeId=6ced195e282e5, content=<a href='/topic/show?id=3c293328175' target=_blank style='color:#2F92EE;'>#动脉瘤蛛网膜下腔出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33281, encryptionId=3c293328175, topicName=动脉瘤蛛网膜下腔出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=198d2500149, createdName=12498bd5m16暂无昵称, createdTime=Mon Jan 18 20:36:44 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913697, encodeId=205a91369e81, content=积分, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=98dc5134227, createdName=146615f7m97暂无昵称, createdTime=Mon Jan 04 20:01:17 CST 2021, time=2021-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1654502, encodeId=de091654502ec, content=<a href='/topic/show?id=5ab788e81d3' target=_blank style='color:#2F92EE;'>#蛛网膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88781, encryptionId=5ab788e81d3, topicName=蛛网膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=396c24497244, createdName=aliceclz, createdTime=Mon Aug 24 15:36:44 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=882197, encodeId=acbb88219e11, content=任务, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=98dc5134227, createdName=146615f7m97暂无昵称, createdTime=Wed Sep 02 15:18:59 CST 2020, time=2020-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809825, encodeId=a8ec809825f3, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200814/81d08245657a4a7f9a1ef713c0ec5878/ec4b201a22194a319b1aeb171bc6bb3d.jpg, createdBy=41e02111625, createdName=1581f8c42cm, createdTime=Mon Aug 17 20:34:17 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1385122, encodeId=228b1385122ce, content=<a href='/topic/show?id=99d99e03311' target=_blank style='color:#2F92EE;'>#长期结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97033, encryptionId=99d99e03311, topicName=长期结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2c31495, createdName=liuyg0228, createdTime=Sun Aug 16 13:36:44 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809099, encodeId=e86e809099ac, content=感谢资料, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=523a1627165, createdName=1dd7ee99m50(暂无匿称), createdTime=Sat Aug 15 09:11:54 CST 2020, time=2020-08-15, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=2001103, encodeId=16be200110326, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Mon Feb 15 19:36:44 CST 2021, time=2021-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1957282, encodeId=6ced195e282e5, content=<a href='/topic/show?id=3c293328175' target=_blank style='color:#2F92EE;'>#动脉瘤蛛网膜下腔出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33281, encryptionId=3c293328175, topicName=动脉瘤蛛网膜下腔出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=198d2500149, createdName=12498bd5m16暂无昵称, createdTime=Mon Jan 18 20:36:44 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913697, encodeId=205a91369e81, content=积分, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=98dc5134227, createdName=146615f7m97暂无昵称, createdTime=Mon Jan 04 20:01:17 CST 2021, time=2021-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1654502, encodeId=de091654502ec, content=<a href='/topic/show?id=5ab788e81d3' target=_blank style='color:#2F92EE;'>#蛛网膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88781, encryptionId=5ab788e81d3, topicName=蛛网膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=396c24497244, createdName=aliceclz, createdTime=Mon Aug 24 15:36:44 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=882197, encodeId=acbb88219e11, content=任务, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=98dc5134227, createdName=146615f7m97暂无昵称, createdTime=Wed Sep 02 15:18:59 CST 2020, time=2020-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809825, encodeId=a8ec809825f3, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200814/81d08245657a4a7f9a1ef713c0ec5878/ec4b201a22194a319b1aeb171bc6bb3d.jpg, createdBy=41e02111625, createdName=1581f8c42cm, createdTime=Mon Aug 17 20:34:17 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1385122, encodeId=228b1385122ce, content=<a href='/topic/show?id=99d99e03311' target=_blank style='color:#2F92EE;'>#长期结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97033, encryptionId=99d99e03311, topicName=长期结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2c31495, createdName=liuyg0228, createdTime=Sun Aug 16 13:36:44 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809099, encodeId=e86e809099ac, content=感谢资料, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=523a1627165, createdName=1dd7ee99m50(暂无匿称), createdTime=Sat Aug 15 09:11:54 CST 2020, time=2020-08-15, status=1, ipAttribution=)]
    2020-08-15 1dd7ee99m50(暂无匿称)

    感谢资料

    0

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