Investigation About Diagnosis And Treatment Of Subarachnoid Hemorrhage In Different Levels Hospital Of Hunan Province(Three, Two, One Level)

Objective:This study was a retrospective analysis to examine the difference of the applications of diagnostic technology, the choice of treatment path and the recent prognosis of subarachnoid hemorrhage (SAH) patients in different levels Hospital of Hunan Province (three, two, one level), which provide a reference for develop a practical, standardized treatment technologies and process of subarachnoid hemorrhage in china and investment policy for the government health resources.Methods:A retrospective cross-sectional survey which comparative analysis. the differences of the clinical data, laboratory data, etiology, symptoms, complications, the applications of diagnostic technology, the choice of treatment path, as well as recent prognosis of a total of three different levels of hospital399cases of subarachnoid hemorrhage (SAH) patients from January2009to July2012.Results:(1) Demographic data:The differences of three different levels (three, two, one) hospital subarachnoid hemorrhage (SAH) patient’s gender, age and height, weight, body mass index and other demographic data was not statistically significant compared with each other (P>0.05).(2) Past medical history data:The differences of three different levels (three, two, one) hospital subarachnoid hemorrhage (SAH) patient’s history of stroke, coronary heart disease, diabetes, hypertension, family history of cerebrovascular disease, taking anti-platelet drugs was not statistically significant compared with each other (P>0.05).The differences of three different levels (three, two, one) hospital subarachnoid hemorrhage (SAH) patient’s history of smoking and drinking history had statistically significant compared with each other(P<0.05).two level hospital subarachnoid hemorrhage (SAH) patients with history of smoking was significantly higher than that of three level hospital and a hospital, The proportion of a hospital subarachnoid hemorrhage (SAH) of drinking history was significantly higher in patients with two level hospital and three level hospital.(3) Symptomatology data:The various ratio of first symptom in399cases of patients:Headache (81.7%), disturbance of consciousness (6.5%), convulsion (3.8%), dizziness (2.5%), neck pillow pain (1.8%), other manifestations (3.8%).The differences of three different levels (three, two, one) hospital subarachnoid hemorrhage (SAH) patient’s Symptomatology was not statistically significant compared with each other (P>0.05).(4)The applications of diagnostic technology:Three different levels of hospitals are using CT scanning in the diagnosis of SAH, But within24hours after onset, The utilization of CT examination in one, two, three hospitals SAH patients were:17.8%,27.5%,42.7%, the difference had statistically significant compared with each other(P<0.05). Application lumbar puncture diagnose SAH, a hospital cannot using lumbar puncture,and the rate of application lumbar puncture is low in two level hospital and three level hospital.Statistical analysis did not undergo.(5) Etiology investigation:In three types of hospitals, a hospital failed to do SAH bleeding etiology examination, and there are52cases of120SAH patients using CTA examination in two level hospital. And it found28case of aneurysms (23.3%).and there are165patients using CTA examination and95patients using DSA examination in three hospital. And it found124cases of aneurysms (69.4%),24cases of Venous malformations(13.4%),30cases of other causes(16.8%).(6) Treatment path:The SAH in a hospital and two level hospital underwent medical treatment, and there are96cases (53.9%) underwent aneurysm surgery,47cases (26.4%) underwent intervention tamponade;35cases (19.7%) underwent medical treatment in three level hospital.(7) The recent prognosis:The mortality of One,two level hospital and three level hospital were19.8%,23.8%,6.8%; The well recovered of One,two level hospital and three level hospital were36.6%,41.7%,69.1%; the difference had statistically significant compared with each other(P<0.05).And there are some differences in recent prognosis of different therapeutic approaches in three level hospital, the difference had statistically significant compared with each other(P<0.05). Conclusion:There are stark differences in the applications of diagnostic technology, the choice of treatment path and the recent prognosis of subarachnoid hemorrhage (SAH) patients in different levels Hospital of Hunan Province (three, two, one level) had statistically significant. Early identification of the diagnosis of SAH, early identification of the cause of bleeding, and early treatment of vascular lesions (ligation or tamponade), the "three early" is the key to improving the recent prognosis of SAH. and there is a large improvement in three different levels of the hospital. Specifically in one or,two level hospital.