Luh Ari Devanita S, I Gede Raka Adhyatma, Kadek Kristian Dwi Cahya
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引用次数: 0
Abstract
Objective: Cerebral vasospasm (CVS) could be an undetected reason for worsening condition in ruptured arteriovenous malformation (AVM) patients during the course. It is important to investigate the risk factors associated with vasospasm in order to establish preventive and therapeutic treatments in a timely manner. This study aimed to describe the risk factors of CVS associated with ruptured AVM.
Methods: We systematically searched electronic databases (PubMed, Science Direct, Cochrane Library, and SSRN) for studies assessing risk factors of CVS associated with spontaneous ruptured AVM. Risk factors assessed include demographic conditions, comorbidities, substance use, lab and vital parameters, and also the severity of bleeding. Meta-analysis was performed using data extracted from each study then Review Manager was used to analyze the risk ratio (RR) with 95% confidence intervals (95% CI).
Results: There were a total of 14 studies included. Chronic renal disease (RR=0.5 [95% CI 0.46-0.67]) and hyperlipidemia (RR=0.78 [95% CI 0.73-0.84]) as comorbid conditions both were found as protective factors. Then the use of substances, including smoking and stimulants, was found to tend to increase the incidence of CVS (RR=1.31 [95% CI 1.11-1.54] and RR=1.31 95% CI 1.11-1.51]) respectively. In the lab and vital parameters section, 8 of them showed results as risk factors for CVS, including leukocytosis (RR=1.58 [95% CI 1.35-1.84]), hyperglycemia (RR=1.17 [95% CI 1.07-1.29]), hyponatremia (RR=1.45 [95% CI 1.23-1.71]), hypokalemia (RR=1.28 [95% CI 1.20-1.36]), fever (RR=1.38 [95% CI 1.23-1.54]), hypovolemia (RR=1.39 [95% CI 1.15-1.67]), acute hypotension (RR=1.4 [95% CI 1.26-1.55]), and electrocardiogram (ECG) abnormality (RR=1.74 [95% CI 1.34-2.26]).
Conclusions: Chronic renal disease and hyperlipidemia were found as protective factors. Meanwhile, smoking, stimulant use, leukocytosis, hyperglycemia, hyponatremia, hypokalemia, fever, hypovolemia, acute hypotension, and ECG abnormalities are risk factors for CVS in patients with AVM rupture.
目的：脑血管痉挛（CVS）可能是破裂动静脉畸形（AVM）患者在治疗过程中病情恶化的一个未被发现的原因。研究与血管痉挛相关的危险因素，以便及时制定预防和治疗措施是十分重要的。本研究旨在描述CVS与AVM破裂相关的危险因素。方法：我们系统地检索电子数据库（PubMed、Science Direct、Cochrane Library和SSRN），以评估CVS与自发性破裂型动静脉畸形相关的危险因素。评估的风险因素包括人口状况、合并症、药物使用、实验室和重要参数，以及出血的严重程度。使用从每个研究中提取的数据进行meta分析，然后使用Review Manager以95%可信区间（95% CI）分析风险比（RR）。结果：共纳入14项研究。慢性肾脏疾病（RR=0.5 [95% CI 0.46-0.67]）和高脂血症（RR=0.78 [95% CI 0.73-0.84]）均为合并症的保护因素。然后发现吸烟和兴奋剂等物质的使用倾向于增加CVS的发生率（RR=1.31 [95% CI 1.11-1.54]和RR=1.31 95% CI 1.11-1.51]）。在实验室和生命参数部分，其中8例显示为CVS的危险因素，包括白细胞过多（RR=1.58 [95% CI 1.35-1.84]）、高血糖（RR=1.17 [95% CI 1.07-1.29]）、低钠血症（RR=1.45 [95% CI 1.23-1.71]）、低钾血症（RR=1.28 [95% CI 1.20-1.36]）、发热（RR=1.38 [95% CI 1.23-1.54]）、低血容量（RR=1.39 [95% CI 1.15-1.67]）、急性低血压（RR=1.4 [95% CI 1.26- 2.26]）和心电图（ECG）异常（RR=1.74 [95% CI 1.34-2.26]）。结论：慢性肾脏疾病和高脂血症是保护因素。同时，吸烟、使用兴奋剂、白细胞增多、高血糖、低钠血症、低钾血症、发热、低血容量、急性低血压、心电图异常是AVM破裂患者CVS发生的危险因素。
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