Frontiers | 动脉瘤性蛛网膜下腔出血早期脑容量增加导致延迟性脑缺血

IF 1.6 4区医学 Q2 SURGERY

Frontiers in Surgery Pub Date : 2024-09-05 DOI:10.3389/fsurg.2024.1467154

Chao Sun, Bin Qin, Jingyu Zhang, Yidan Liang, Cui Min, Qiang Yang, Yanglingxi Wang, Jian Gong, Yi Xiang

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引用次数: 0

摘要

方法对2020年1月至2023年1月期间重庆医科大学附属第一医院神经外科重症监护室收治的自发性动脉瘤性蛛网膜下腔出血患者进行回顾性分析。对临床数据、治疗结果和影像学数据进行了分析。使用 3D-Slicer 软件评估出血后两个时间点的脑容量：24 小时内和 24 至 48 小时之间。脑容量膨胀率定义为两次测量值的绝对差值与较小值之比。根据已确立的延迟性脑缺血诊断标准，将患者分为两组。进行单变量和多变量逻辑回归分析，以确定影响延迟性脑缺血的因素。46例患者在出血后出现延迟性脑缺血。与非 DCI 组（3.59 ± 2.62）相比，DCI 组的脑容量肿胀率（10.66 ± 8.45）更大，差异有统计学意义。此外，高龄、吸烟史、高血压史、意识丧失、Hunt-Hess 分级差、mFisher 评分高、24 小时内脑容量和 IVH 在两组之间也存在统计学差异。多变量逻辑回归分析显示，在调整了高龄、吸烟史、高血压史、Hunt-Hess 分级差、mFisher 评分高、24 小时内脑容量和 IVH 后，脑容量膨胀率是 DCI 的独立危险因素。脑容量膨胀率较大是发生延迟性脑缺血的独立危险因素，对延迟性脑缺血的发生率具有重要的预测价值。

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Frontiers | Increased Brain Volume in the Early Phase of Aneurysmal Subarachnoid Hemorrhage leads to Delayed Cerebral Ischemia

ObjectiveTo investigate the correlation between the swelling rate of brain volume within the first 48 h after aneurysmal subarachnoid hemorrhage and the subsequent development of delayed cerebral ischemia.MethodsA retrospective analysis was conducted on patients with spontaneous aneurysmal subarachnoid hemorrhage admitted to the Neurosurgery Intensive Care Unit of the First Affiliated Hospital of Chongqing Medical University between January 2020 and January 2023. The clinical data, treatment outcomes, and imaging data were analyzed. Brain volume was evaluated using 3D-Slicer software at two time points post-hemorrhage: within the first 24 h and between 24 and 48 h. The swelling rate of brain volume was defined as the ratio of the absolute difference between two measurements to the smaller of values. Patients were categorized into two groups based on established diagnostic criteria of delayed cerebral ischemia. Univariate and multivariate logistic regression analyses were performed to identify factors influencing delayed cerebral ischemia.ResultsA total of 140 patients were enrolled in this study. 46 patients experienced delayed cerebral ischemia after bleeding. The swelling rate of brain volume was larger in the DCI group (10.66 ± 8.45) compared to the non-DCI group (3.59 ± 2.62), which showed a statistically significant difference. Additionally, advanced age, smoking history, history of hypertension, loss of consciousness, poor Hunt-Hess grade, high mFisher score, brain volume within 24 h, and IVH were also statistically different between the two groups. Multivariate logistic regression analysis revealed that the swelling rate of brain volume was an independent risk factor for DCI with adjusting the advanced age, smoking history, history of hypertension, poor Hunt-Hess grade, high mFisher score, brain volume within 24 h, and IVH.ConclusionBrain volume significantly increased in patients with aneurysmal subarachnoid hemorrhage during the early phase (within 48 h post-onset). The larger swelling rate of brain volume is an independent risk factor for the development of delayed cerebral ischemia, and it may hold significant predictive value for the incidence of delayed cerebral ischemia.

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来源期刊

Frontiers in Surgery Medicine-Surgery

CiteScore

1.90

自引率

11.10%

发文量

1872

审稿时长

12 weeks

期刊介绍： Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.