Analysis Of Influence Factors Of Delayed Cerebral Ischemia After Ruptured Aneurysm

Part oneA meta study concerning influence factor of aneurysmal subarachnoid hemorrhage induced delayed cerebral ischemiaObjective:Currently,the conclusion of influence factors of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage is not unified,especially the way of treatment of DCI has large difference that between coiling and clipping.So we try to study the influence factor and its risk of aneurysmal subarachnoid hemorrhage induced delayed cerebral ischemiathrough meta-analysis,for providing valuable information towards SAH patients from DCI.Methods:We collected most current 10 years’ references from PubMed concerning the current topic.By using the Revman 5.2 software,we applied meta analysis towards the data from these references and calculated the OR(95%CI)for each factors listed.Results:There are a total of 13 publication enrolled,which covered 5084 patients in total.The meta-analysis showed that OR(95%CI)of influence factor included gender 0.87(0.68-1.12),hypertension 1.26(0.76-2.09),smoking history 1.28(0.92-1.77),Clinical grade at hospital admission 0.35(0.27-0.46),Fisher grade 0.38(0.22-0.65),treatment 0.70(0.60-0.81),and aneurysm location 1.23(0.88-1.71).Conclusion: Clinical grade,Fisher grade and treatment are the influence factors for DCI after aneurysmal subarachnoid hemorrhage.Gender,hypertension,smoking habit and the site of aneurysm have no significant relationship of DCI.This conclusion requires verification from other studies using larger sample size and multi-centre studies.Part twoA study concerning influence factors of ruptured aneurysm induced delayed cerebral ischemia after surgical treatment(single center)Objective:Analysis the incidence rate,influence factor,and clinical feature of ruptured aneurysm induced DCI after surgical treatment in our hospital,study the influence factors of DCI for further research,in order to provide more evidence of improving the prognosis of patients who had ruptured aneurysm.Methods:We conducted a retrospective study of the patients who enrolled between January 2013 and June 2016 received surgery during the two-weeks window after aneurysm ruptured,analyzed of the influence factors of DCI and its clinical features.Results:Delayed cerebral ischemia occurred in 10.7% patients of ruptured aneurysm after surgical treatment.There are significant relationship between treatment(OR =6.645,P<0.05)and Fisher grade(OR =5.325,P<0.05)by multivariate logistic regression.In Fisher grade I-II,the incidence rate of DCI are extremely low in both coiling group and clipping group,each rate of that are 2.4% and 4.8%.In Fisher grade III-IV,the incidence rate of DCI in coiling group and clipping group are 3.4% and 27.7%,there has statistically difference in two groups.The DCI location was on the same side of operation,also on the opposite side of operation,but all on the same with more serious side of SAH.Conclusion: Clipping treatment and Fisher grade≥III were the independent influence factors for DCI following ruptured aneurysm,but only the patient in Fisher grade≥III for surgical clipping operation have high risk of DCI on the incidence,we should pay much attention on these patient.In addition,the DCI location has significant correlation with subarachnoid hemorrhage part,and the CVS is more serious in the part with more bleeding.