Analysis Of The Related Factors For Preoperative Rebleeding Of Aneurysmal Subarachnoid Hemorrhage

Objective The purpose of this study was to summarize the incidence of rebleeding in patients with aSAH before the operation(including surgical clipping and endovascular intervention),and to investigate the occurrence time and related risk factors of rebleeding,so as to provide clinical basis for the prevention and treatment of preoperative rebleeding.Methods From June 2012 to October 2018,the clinical datas of 603 aSAH patients hospitalized in our hospital were retrospectively analyzed,the patients were divided into the rebleeding group(79 cases)and the non-rebleeding group(524 cases)according to whether the rebleeding occurred before the operation,univariate analysis was used to compare the differences in general conditions,clinical manifestations,complications and imaging datas between the two groups,and multivariate Logistic regression analysis was performed to analyze the risk factors of preoperative rebleeding.Results(1)There were 79 cases of the 603 aSAH patients suffered rebleeding before the operation,and the incidence of rebleeding was 13.1%(79/603).Among them,20 cases(25.3%)occurred within the first day after thefirst bleeding.(2)Among the 20 aSAH patients whose rebleeding occurred within the first day after the first bleeding,11 cases(55.0%)occurred within the first 6hours after the first bleeding,and 15 cases(75.0%)occurred outside the hospital.(3)According to the results of univariate analysis,the differences between the two groups in sentinel headache(P=0.001),disturbance of consciousness(P=0.000),epileptic seizure(P=0.000),diastolic blood pressure(P=0.011),GCS score(P=0.000),Hunt-Hess grade(P=0.000),intracranial hematoma(P=0.000),intraventricular hemorrhage(P=0.000),extraventricular drainage(P=0.001),aneurysm site(P=0.007),aneurysm shape(P=0.002),Fisher grade(P=0.000)were significant.(4)Multivariate Logistic regression analysis showed that sentinel headache(P=0.007),high Hunt-Hess grade(P=0.013),intracranial hematoma(P=0.004),posterior circulation aneurysm(P=0.027),irregular aneurysm shape(P=0.001),high Fisher grade(P=0.010)may be risk factors for preoperative rebleeding in aSAH patients.Conclusion(1)The incidence of preoperative rebleeding in aSAH patients was 13.1%(79/603),and the first day after the first bleeding was the peak of rebleeding.The incidence of rebleeding on the first day was the highest within the first 6 hours and mainly occurred outside the hospital.(2)sentinel headache,high Hunt-Hess grade,intracranial hematoma,posterior circulation aneurysm,irregular aneurysm shape,high Fisher grade may be important risk factors for preoperative rebleeding in aSAH patients.