Factors Associated With Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

Objective: Delayed cerebral ischemia (DCI) is one of the seriouscomplications after aneurysmal subarachnoid hemorrhage, this may contributeto disability and death in hospitalized patients. DCI generally occurs within2weeks after the onset of aSAH patients, about30%of patients occur DCI,eventually leading to severe disability and even death. There is no uniformstandard about the pathogenesis of DCI. This study was designed by aretrospective analysis of the relationship between clinical observations anddelayed ischemic of aneurysmal subarachnoid hemorrhage, to filter out thesignificant associated risk factors,early to assess the patient’s condition,predict the occurrance of DCI,treat the patients actively, strengthening themonitoring of perioperative, timely processing of adverse reactions, reduceoccurrance of cerebral ischemic complications after treating the aneurysms,minimize mortality and morbidity, and achieve the purpose of improving theprognosis of patients.Methods: Collect the clinical data about the patients with aneurysmalsubarachnoid hemorrhage from June,2011to June,2012in Neurosurgery,Second Hospital of Hebei Medical University. Analysis the age, sex, smokinghistory, blood pressure on admission, aneurysm site, the size of the aneurysm,glasgow coma scale, Hunt-Hess classification, modified Fisher grade,treatment modalities, timing of surgery, admission blood glucose, WBC count,potassium, sodium, calcium and other related indicators retrospective, assesspatients with6-month follow-up results using the GOS score scale. Grouppatients with these different factors depending on whether the delayed cerebralischemia occured, analysis datas using univariate and multivariate logisticregression with SPSS18.0statistical software, and determine the correlationfactors about delayed cerebral ischemia. Results:193patients met the study criteria,66patients occured delayedcerebral ischemia, the incidence rate is34.2%. Univariate analysis resultsshow that the timing of surgery, smoking history, electrocardiogram, serumsodium ion concentration, glasgow coma scale, Hunt-Hess grade and modifiedFisher grade was statistically significant (P<0.05). Patients of late surgery,with smoking history, ECG abnormalities, hyponatremia, low Glasgow ComaScale score,high Hunt-Hess grade and high modified Fisher grade has muchprobability of occurring delayed cerebral ischemia. Select craniotomy clippingor embolization, have no direct impact on the occurrance of DCI(P＞0.05),but patients selecting interventional embolism would have a low incidence ofDCI if the surgery operated early(P<0.05). Multivariate Logistic regressionanalysis showed that: with smoking history(OR=9.462,95%CI:2.782-32.18),hyponatremia(OR=2.285,95%CI:1.232-4.235), high Hunt-Hess grade (OR=2.223,95%CI:1.011-4.891) regression coefficient (b)>O, OR>1,indicates anindependent risk factor for delayed cerebral ischemia(P<0.05). Judge patientswith six month following-up, a total of33(17.1%) cases of death and severedisability in patients with a total of32(16.6%) cases, calculate after grouping,the results show that the patients who had occurred delayed cerebral ischemiawould have an increased morbidity and mortality (P<0.05).Conclusion:1、Smoking history, hyponatremia, high Hunt-Hess gradewere independent risk factors for delayed cerebral ischemia after aneurysmalsubarachnoid hemorrhage.2、Early surgical treatment after the onset ofaneurysmal subarachnoid hemorrhage patients should be operated, especiallythe patients preparing for interventional embolization. Patients with smokinghistory, ECG abnormalities, hyponatremia, low Glasgow Coma Scale score,high Hunt-Hess grade and high modified Fisher grade prone to occur delayedcerebral ischemia, they should be monitored closely.3、Patients who hadoccurred delayed cerebral ischemia would have a relatively poor prognosis,they would have an elevated disability and mortality.