Analysis Of Prognostic Factors For Outcome In Patients Underwent Microsurgery After Aneurysmal Subarachnoid Hemorrhage

Objective To investigate the prognostic factors effected outcome in a large series of patients underwent neurosurgical clipping of aneurysms after aneurysmal subarachnoid hemorrhage(aSAH) , to describe the interaction and intercommunication of these factors, then hope to find out good approaches to improve the prognosis.Methods The clinical data of 137 patients underwent neurosurgical clipping of aneurysms after aSAH were followed up in our department between 2004 and 2008, and the outcome of those cases were measured by the Glasgow outcome scale, then a retrospective analysis was made about the fourteen prognostic factors including age and so on.Results In univariable analysis, unfavorable outcome was associated with age older than 50 (x~2=4.313, P=0.038) ,aneurysm size larger than 10 mm (x~2=8.303, P=0.004) ,Hunt and Hess Grade above III on admission (x~2=46.861, P=0.000) ,Fisher Scale above 2 on admission (x~2=33.748, P=0.000) ,temperature higher than 38.5℃(x~2=4.177, P=0.041) and cerebral infarction on CT after surgery(x~2= 12.017, P=0.001 ).The gender, admission systolic blood pressure, multiple aneurysms, aneurysm intraoperative rupture, temporary break the parent artery of aneurysm, operative region use of papaverine , lumbar puncture after operation and intravenous vasodilator influencing on the prognosis have no statistical significance. In multivariable analysis, unfavorable outcome was associated with aneurysm size larger than 10mm(OR=5.689, P=0.017),Hunt and Hess Grade above III on admission(OR=6.636, P=0.033),Fisher Scale above 2 on admission (OR=6.328, P=0.041) and cerebral infarction on CT after surgery (OR=5.054, P=0.032) .Conclusion (1) Aneurysm size larger than 10mm, age older than 50 ,Hunt and Hess Grade above III on admission ,Fisher Scale above 2 on admission ,cerebral infarction on CT after operation ,those factors were strongly associated with poor outcome after aSAH. (2) Some prognostic factors influenced outcome after SAH were presented on admission and were not modifiable, such as age, aneurysm size, grade on admission ,but cerebral infarction after surgery was an important potentially treatable factor.