Characteristics and prognostic value of acute catecholamine surge in patients with aneurysmal subarachnoid hemorrhage

Abstract

Objectives: The characteristics of serum catecholamine concentration at the hyper-acute phase of aneurysmal subarachnoid hemorrhage (SAH) and its relationship between patient outcome and delayed vasospasm were investigated.

Methods: Patients with aneurysmal SAH (170) were prospectively studied between August 2008 and June 2011. Baseline demographic data and physiological parameters, including plasma concentrations of adrenaline (AD), noradrenaline (NA), and dopamine (DP) were evaluated for all patients.

Results: On admission, plasma AD, NA, and DP levels were significantly higher in patients with a poor clinical grade on admission (Hunt and Kosnik grade: IV–V), compared to those with a good clinical grade on admission (Hunt and Kosnik grade: I–III). AD showed a markedly high concentration immediately after the onset of SAH and then rapidly decreased. NA levels peaked within 6 hours after onset, then significantly decreased. The increase of DP with time was not significant, but showed a similar trend to that of NA. The level of each catecholamine showed significant mutual correlation.

Our multivariate model demonstrated that age, poor clinical grade at admission, plasma AD and NA levels were good predictors of poor patient outcome [receiver operating characteristic (ROC) area: 0·83]. And that poor clinical grade at admission, Fisher scale, blood sugar level and plasma AD level were good predictors of the development of delayed vasospasm (ROC area: 0·81) (1·3).

Conclusions: The present findings suggest that sympathetic activation in patients in the acute phase of SAH reflects the severity of SAH, and is closely related to the development of delayed vasospasm, leading to the subsequent immune response and inflammatory reactions. Strategies for suppressing catecholamine at the hyper-acute phase may contribute to vasospasm prevention and improve patient outcome.     

Hypertensive intracerebral hematoma after aneurysmal subarachnoid hemorrhage

We report a patient with sequential intracerebral hematoma in bilateral basal ganglia after an aneurysmal subarachnoid hemorrhage. A 55-year-old woman presented with sudden loss of consciousness without a past history of hypertension. Subarachnoid hemorrhage secondary to a ruptured anterior communicating artery aneurysm was seen on initial CT and an intracerebral hematoma was observed in both basal ganglia 3 hours later on a follow-up CT scan. We suggest that delayed intracerebral hematoma may occur due to increased intracranial pressure caused by aneurysmal rupture and discuss the possible mechanisms of this occurrence.     

早期DSA检查对蛛网膜下腔出血的临床意义

蛛网膜下腔出血（subarachnoid hemorrhage，SAH）是临床发病率和死亡率均较高的急性脑血管病之一，并呈逐年增高趋势。随着神经介入影像学的发展，对急性SAH患早期（72h内1开展数字减影血管造影（digital subtraction angiography．DSA）检查，使SAH的早期病因诊断及病因治疗成为可能，患的预后也得到显改善。我院自2003年1月至2006年4月收治96例SAH患行早期DSA检查并给予相应的病因治疗．取得较好的临床疗效。现将有关资料与临床治疗总结报道如下。[第一段]     

动脉瘤性蛛网膜下腔出血后慢性脑积水的诊治

目的探讨动脉瘤性蛛网膜下腔出血(aSAH)后慢性脑积水的诊断与治疗方法。方法回顾性分析33例经手术治疗的aSAH后慢性脑积水患者的临床资料。结果治疗后随访6月～2年,按GOS评分,恢复良好27例,轻残3例,重残2例,死亡1例。结论慢性脑积水是aSAH后的常见并发症,脑室-腹腔分流术是aSAH后慢性脑积水的有效治疗方法。     

The 100 most influential publications pertaining to intracranial aneurysms and aneurysmal subarachnoid hemorrhage

The study of intracranial aneurysms has grown at an astounding rate since Sir Charles Symond’s association of hemorrhage within the subarachnoid space to intracranial aneurysms in 1923. These associations led to the first surgical treatment of an intracranial aneurysm with wrapping by Norman Dott in 1931, and shortly thereafter, clip ligation by Walter Dandy in 1938. Surgical outcomes were improved by the introduction of the operative microscope in the 1960s and perioperative care utilizing induced hypertension, hypovolemia, and hemodilution (“HHH therapy”). Recent monumental advancements, such as coil embolization in 1990 by Guglielmi, have continued to advance the field forward. The authors hope to highlight some of the most seminal and influential works. Herein, we utilize the technique of citation analysis to assemble a list of the 100 most influential works pertaining to aneurysmal subarachnoid hemorrhage published between the years 1900 and 2015 to honor these individuals and to provide guidance to current and future researchers in the field. We additionally calculate the effects of author, journal, topic, and study design on the overall influence of publications in this field.     

动脉瘤性蛛网膜下腔出血患者认知功能研究

目的通过对动脉瘤性蛛网膜下腔出血患者认知功能的动态评估,探讨认知功能变化的临床意义。方法选择颅内前循环动脉瘤100例,并经血管内治疗或开颅夹闭处理。在入院时、出院时和出院后2月以简易智能量表等评估患者的认知功能。结果100例动脉瘤性蛛网膜下腔出血患者认知功能损害率入院时37.0%,出院时60.0%,出院后2月38.0%;出院时认知功能损害率高于入院时（P〈0.01）和出院后2月（P〈0.01）;认知功能损害主要反应在注意力和计算力、短程记忆和反应速度等方面;血管内治疗组和开颅夹闭组出院时和出院2月时认知功能损害率均差异显著（P〈0.05）。结论动脉瘤性蛛网膜下腔出血患者在不同时间段存在不同程度的认知功能损害,前瞻性预防和外科处理措施的改进能提高该类患者的生活质量。     

眼跳潜伏期预测动脉瘤性蛛网膜下腔出血后迟发性脑缺血的研究

目的探讨眼跳潜伏期对动脉瘤性蛛网膜下腔出血(SAH)后迟发性脑缺血(DCI)的预测作用。方法回顾性选择2012年1月~2016年12月来我院接受治疗的SAH患者110例。根据患者入院后30天内有无并发迟发性脑缺血(DCI)分为并发DCI组(n=40)和未并发DCI组(n=70)。应用单因素、多因素非条件Logistic回归分析探讨影响SAH患者DCI发生的危险因素。结果眼跳频率、眼跳总时间、单次眼跳平均时间、眼跳总幅度、眼跳平均幅度、眼跳平均速度、眼跳潜伏期预测SAH后DCI发生的诊断界值分别为2.65次/s、1685.45 ms、39.03 ms、553.25°、8.05°、118.35°/s、375.42 ms。Hunt-Hess分级≥Ⅲ级、Fisher分级≥Ⅲ级、脑积水程度(中度、重度)、眼跳潜伏期≥375.42 ms会增加SAH后DCI发生风险(P0.05)。结论眼跳潜伏期可预测SAH后DCI发生。     

去骨瓣减压术在动脉瘤蛛网膜下腔出血患者中的应用

目的探讨去骨瓣减压术在动脉瘤蛛网膜下腔出血患者中的应用效果。方法选择2013-08—2014-08我院收治的100例动脉瘤蛛网膜下腔出血患者,按照患者入院顺序分为观察组和对照组各50例。观察组采用去骨瓣减压术进行治疗,对照组采用开颅手术治疗,比较2组患者术后恢复情况及手术效果、并发症等。结果观察组总有效率88%,对照组56%,2组总有效率差异有统计学意义(P0.05);观察组术后恢复情况有所改善,病死率低于对照组;观察组术后并发症率(18%)较对照组(62%)减少,2组患者在术后并发症、手术效果及术后恢复情况方面差异有统计学意义(P0.05)。结论动脉瘤蛛网膜下腔出血患者采用去骨瓣减压术可以有效清除动脉瘤、减少术后并发症,患者术后恢复效果优于开颅手术患者,进而有效改善了治疗效果。     

Prognostic factors varying with age in patients with aneurysmal subarachnoid hemorrhage

With the advent of an aging society, more elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) have been treated. We investigated if prognostic factors differ with age in aSAH patients. In a prospectively maintained aSAH database at multiple institutions from 2013 to 2016, 238 patients who underwent clipping or coiling for a ruptured aneurysm within 48 h of onset were divided into elderly (≥75 years; 57 patients) and non-elderly groups, or categorized into 4-age groups (<54, 55–64, 65–74, and ≥75 years). Prognostic factors and clinical characteristics were retrospectively analyzed. The elderly group had a higher incidence of pre-morbidities, co-morbidities, poor admission World Federation of Neurological Surgeons (WFNS) grades, modified Fisher grade 4, and resultantly 90-day poor outcomes (modified Rankin scale [mRS] 3–6). Multivariate logistic regression analyses revealed that independent determinants for poor outcomes were hypertension and modified Fisher grade 4 in the elderly group, and admission WFNS grades IV–V, systemic complications, non-procedural cerebral infarction and shunt-dependent chronic hydrocephalus in the non-elderly group. The 4-age group analyses showed that higher age group was more frequently associated with the prognostic factors. As higher age itself causes poor outcomes and more association of prognostic factors, prognostic factors in elderly patients may be rather limited.     

Multiplexed protein profiling after aneurysmal subarachnoid hemorrhage: Characterization of differential expression patterns in cerebral vasospasm

Cerebral vasospasm is a major contributor to delayed morbidity following aneurysmal subarachnoid hemorrhage. We sought to evaluate differential plasma protein levels across time in patients with aneurysmal subarachnoid hemorrhage to identify potential biomarkers and to better understand the pathogenesis of cerebral vasospasm. Nine female patients with aneurysmal subarachnoid hemorrhage underwent serial analysis of 239 different serum protein levels using quantitative, multiplexed immunoassays (DiscoveryMAP 250+ v2.0, Myriad RBM, Austin, TX, USA) on post-hemorrhage days 0 and 5. A repeated measures analysis of variance determined that mean protein concentration decreased significantly in patients who developed vasospasm versus those who did not for alpha-2-macroglobulin (F [1.00,7.00] = 16.33, p = 0.005), angiogenin (F [1.00,7.00] = 7.65, p = 0.028), apolipoprotein A-IV (F [1.00,7.00] = 6.308, p = 0.040), granulocyte colony-stimulating factor (F [1.00,7.00] = 9.08, p = 0.020), macrophage-stimulating protein (F [1.00,7.00] = 24.21, p = 0.002), tetranectin (F [1.00,7.00] = 5.46, p < 0.039), vascular endothelial growth factor receptor 3 (F [1.00,7.00] = 6.94, p = 0.034), and significantly increased for vitronectin (F [1.00,7.00] = 5.79, p = 0.047). These biomarkers may be of value in detecting cerebral vasospasm, possibly aiding in the identification of patients at high-risk prior to neurological deterioration.     

长时程亚低温治疗高分级动脉瘤性蛛网膜下腔出血的临床分析

目的 探讨长时程亚低温治疗对高分级动脉瘤性蛛网膜下腔出血（aSAH）患者的临床疗效.方法 回顾性纳入首都医科大学宣武医院神经外科重症监护室2015年3月至2017年1月收治的58例行长时程亚低温治疗的高分级aSAH患者,其中24例行显微外科动脉瘤夹闭术,34例行血管内栓塞治疗.出院后对患者行门诊或电话随访,随访内容为改良Rankin量表评分（mRS）.结果 58例高分级aSAH患者长时程亚低温治疗的时程为5～14 d,平均（7.0±4.4）d.治疗期间,37例（63.8％）患者出现心律失常,50例（86.2％）出现低血压,8例（13.8％）出现下肢深静脉血栓;54例（93.1％）出现胃肠动力障碍,8例（13.8％）出现应激性溃疡;30例（51.7％）出现肺炎,4例（6.9％）出现急性呼吸窘迫综合征;28例（48.3％）出现脑血管痉挛;21例（36.2％）出现寒战;17例（29.3％）出现凝血功能障碍;15例（25.9％）出现应激性高血糖,13例（22.4％）出现低白蛋白血症;6例（10.3％）出现导管相关性感染;10例（17.2％）出现迟发性脑缺血.8例（13.8％）患者死亡.单因素分析显示,发病后Hunt-Hess高分级（Ⅳ、Ⅴ级）及脑血管痉挛是影响患者在长时程亚低温治疗期间死亡的危险因素（均P ＜0.05）.46例患者的随访时间为3～6个月,平均（4.3±1.9）个月.其中56.5％（26/46）的患者预后良好,43.5％（20/46）预后不良.预后不良的患者中,6例死亡,14例中、重度残疾.结论 长时程亚低温疗法能改善高分级aSAH患者的预后.     

Analysis of risk factors correlated with angiographic vasospasm in patients with aneurysmal subarachnoid hemorrhage using explainable predictive modeling

Cerebral vasospasm (CAV) is a major complication of aneurysmal subarachnoid hemorrhage (aSAH) in patients with ruptured intracranial aneurysm. Explainable artificial intelligence (XAI) was used to analyze the contribution of risk factors on the development of CAV. We obtained data about patients (n = 343) treated for aSAH in our hospital. Predictive factors including age, aneurysm size, Hunt and Hess grade, and modified Fisher grade were used as input to analyze the contribution and correlation of factors correlated with CAV using a random forest regressor. An analysis conducted using an XAI model showed that aneurysm size (27.6%) was most significantly associated with the development of CAV, followed by age (20.7%) and Glasgow coma scale score (7.1%). In some patients with an estimated artificial intelligence-selected CAV value of 51%, the important risk factors were aneurysm size (9.1 mm) and location, and hypertension is also considered a major influencing factor. We could predict that Fisher grade 3 contributed to 20.3%, and the group using Antiplatelet contributed to 12.2% which is expected to lower cerebral CAV compared to the Control group (16.9%). The accuracy rate of the XAI system was 85.5% (area under the curve = 0.88). Using the modeling, aneurysm size and age were quantitatively analyzed and were found to be significantly associated with CAV in patients with aSAH. Hence, XAI modeling techniques can be used to analyze factors correlated with CAV by schematizing prediction results in some patients. Moreover, poor Fisher grade and use of postoperative antiplatelet agent are important factors for prediction of CAV.     

动脉瘤破裂致蛛网膜下腔出血患者死亡原因分析

目的 探讨动脉瘤破裂致蛛网膜下腔出血患者住院期间死亡的原因并提出相应的对策. 方法 回顾性分析江苏大学附属人民医院神经外科自2003年1月至2010年12月收治且住院期间死亡的24例颅内动脉瘤破裂致自发性蛛网膜下腔出血患者的临床资料和死亡原因.结果 死亡原因分别为:颅内再出血11例,其中术前再出血5例,介入栓塞术中出血3例,栓塞术后颅内再次出血3例;术后脑血管痉挛或脑梗死8例,其中早期(术后3d内)CT表现为脑梗死3例,晚期(术后3d后)脑血管痉挛或脑梗死5例;椎动脉瘤栓塞术后呼吸骤停1例;肺部感染3例;肾功能衰竭1例. 结论 颅内再次出血、脑梗死或脑血管痉挛、非神经系统并发症是动脉瘤性蛛网膜下腔出血患者住院期间主要的死亡原因.     

颅内动脉瘤破裂致蛛网膜下腔出血合并硬膜下血肿的临床病理研究

目的探讨蛛网膜下腔出血（ＳＡＨ）合并硬膜下血肿（ＳＤＨ）的临床特点和机理。方法对１６例经ＣＴ、脑血管造影、手术和１１例尸解证实的颅内动脉瘤破裂致ＳＡＨ合并ＳＤＨ患者进行临床及病理特点分析。结果临床表现意识障碍１２例,玻璃体下出血７例,死亡１３例。导致ＳＡＨ合并ＳＤＨ的原因可能为：（１）动脉瘤破裂,大量血液破入蛛网膜下腔,撕破蛛网膜;（２）伴随的脑内血肿破入蛛网膜下腔并撕破蛛网膜;（３）发病时突发意识丧失、摔倒,致头部外伤。结论颅内动脉瘤致ＳＡＨ可合并ＳＤＨ,其预后不佳,病死率高,ＣＴ阴性者不能完全排除合并ＳＤＨ的可能。     

硫酸镁对颅内动脉瘤性蛛网膜下腔出血后脑血管痉挛的治疗作用

目的观察硫酸镁对动脉瘤性蛛网膜下腔出血后症状性脑血管痉挛和神经功能预后的治疗作用。方法39例动脉瘤性蛛网膜下腔出血患者在发病48 h内,随机分到生理盐水组(A组)、硫酸镁治疗1组(B组)、硫酸镁治疗2组(C组),B组首次静脉推注25％硫酸镁10 mL后,继以每日25％硫酸镁40 mL静脉滴注,C组首次静脉推注25％硫酸镁20 mL后,继以每日25％硫酸镁80 mL静脉滴注,A组输入等量生理盐水,均连续输入14 d并每日检测血清Mg2+浓度、血压及TCD检测大脑中动脉平均血流速度。6个月后随访并记录患者Glasgow Outcome Scall-Extended、Modified Rankin Scall用以评价患者神经功能预后情况。结果17例患者发生症状性脑血管痉挛,A组7例,B组5例、C组5例;17例症状性脑血管痉挛患者的6个月GOSE评分,A组1／7例,B组3／5例、C组3／5例患者神经功能恢复良好;39例患者中硫酸镁治疗组患者6个月后GOSE、Modified Rankin Scale评分与生理盐水组比较,神经功能预后有改善倾向。然而,这些疗效评分差异均没有达到统计学意义(P>0．05)。结论硫酸镁治疗安全且血清Mg2+水平较容易维持,硫酸镁有减少症状性脑血管痉挛发生和改善患者神经功能预后的趋势,但由于样本例数较少,其治疗作用仍有待于进一步研究证实。     

内皮型一氧化氮合成酶T786C、白细胞介素-6 C572G基因多态性与动脉瘤性蛛网膜下腔 出血的相关性研究

目的 探讨eNOS T786C、IL-6 C572G单核苷酸多态性与动脉瘤性蛛网膜下腔出血的相关性。方法 收集2014年1月-2016年2月就诊于内蒙古包头市中心医院的动脉瘤蛛网膜下腔出血患者71例及非蛛网膜下腔出血或健康人群142例基线资料[实验组与对照组1:2,性别相同,年龄35～81岁,平均年龄(55.07±9.98)岁],采集抗凝血标本,应用聚合酶链式反应(PCR)和限制性片段长度多态性(RFLP)分析方法检测实验组及对照组基因型,实验组和对照组之间基因型分布和等位基因频率分布比较采用χ²检验,明确各基因型与散发颅内破裂动脉瘤蛛网膜下腔出血疾病之间的相关性。结果 实验组与对照组eNOS T786C、IL-6 C572G各基因型、等位基因无明显差异(P>0.05); 实验组与对照组高血压病、长期吸烟人数有明显差异(P<0.05),其余指标均无明显差异(P>0.05)。结论 eNOS T786C、IL-6 C572G基因多态性与破裂的动脉瘤性蛛网膜下腔出血无关。     

Neuropsychiatric disturbance after aneurysmal subarachnoid hemorrhage

Although aneurysmal subarachnoid hemorrhage (aSAH) accounts for only 3–5% of all strokes, a high degree of morbidity has been reported in this relatively young subset of patients. Neuropsychiatric disturbance has often been neglected in these reports. We aimed to investigate the pattern and pathological factors of chronic neuropsychiatric disturbance in aSAH patients. This cross-sectional observational four-center study was carried out in Hong Kong. Neuropsychiatric outcome (Neuropsychiatric Inventory Chinese Version [CNPI]) assessments were conducted cross-sectionally 1–4 years after ictus. Pathological factors considered were early brain injury as assessed by admission World Federation of Neurosurgical Societies grade, aneurysm treatment (clipping versus coiling), delayed cerebral infarction, and chronic hydrocephalus. One hundred and three aSAH patients’ spouses or caregivers completed the CNPI. Forty-two (41%) patients were reported to have one or more domain(s) of neuropsychiatric disturbance. Common neuropsychiatric disturbance domains included agitation/aggression, depression, apathy/indifference, irritability/lability, and appetite/eating disturbance. Chronic neuropsychiatric disturbance was associated with presence of chronic hydrocephalus. A subscore consisting of the five commonly affected domains seems to be a suitable tool for aSAH patients and should be further validated and replicated in future studies.     

C-反应蛋白与动脉瘤性蛛网膜下腔出血临床预后的关系

目的探讨动脉瘤性蛛网膜下腔出血(a SAH)血清C-反应蛋白(CRP)动态变化趋势及其与临床预后的关系。方法2014年1月至2015年8月前瞻性收集符合标准的a SAH 108例,发病72 h内行夹闭术(72例)或血管内栓塞(36例)。术后3个月采用GOS评分评估预后,4~5分为预后良好,1~3分为预后不良。入院时、术后1、3、5、7 d及出院当天,采集清晨空腹静脉血,检测血清CRP水平。采用多因素Logistic回归分析检验预后不良危险因素。结果 108例中,预后良好68例,预后不良40例。多因素Logistic回归分析显示,术后1、3 d血清CRP水平增高是a SAH不良预后的独立危险因素。受试者工作特征曲线分析结果术后3 d血清CRP水平[曲线下面积(AUC)=0.823]与术后1 d(AUC=0.861)相比,对不良预后的发生具有更好的预测价值。术后1 d血清CRP与入院时GCS评分、入院时Fisher评分和入院时Hunt-Hess分级均无明显相关性(P0.05)。术后3 d血清CRP水平与入院时GCS评分无明显相关性,但与入院时Fisher评分(r=0.28;P0.05)、入院时Hunt-Hess分级(r=0.42;P0.05)存在明显相关性。结论术后3 d血清CRP水平升高是a SAH不良预后的独立危险因素,能为不良预后的识别提供临床指导。     

吸烟对动脉瘤性蛛网膜下腔出血患者脑循环的影响

目的 探讨内皮一氧化氮合酶基因T-786C多态对吸烟的动脉瘤性蛛网膜下腔出血患者脑循环的影响. 方法 收集自2006年至2008年广州军区武汉总院神经外科住院的动脉瘤性蛛网膜下腔出血汉族患者394例,根据每年吸烟量≥200支和0支将其分为吸烟组(198例)和不吸烟组(196例).彩色多普勒(TCCD)检测以上患者脑血流速度,等位基因特异性聚合酶链反应测定T-786C多态性,并通过患者尿液中F2-异前列烷排泄物来评估吸烟者的氧化应激程度. 结果 TCCD频谱提示,吸烟组中一部分患者大脑中动脉(MCA)和颈内动脉(ICA)的平均血流速度(Vm)较正常值呈明显增高趋势,而不吸烟组中MCA和ICA的Vm与正常值无明显差别.吸烟组患者不同基因型中MCA Vm、ICA Vm差异有统计学意义(P＜0.05),其中CC基因型MCA Vm[(160.9±58.5)cm/s]明显高于TT[(95.8±56.3)cm/s]、TC[(94.1±51.3)cm/s]基因型,差异有统计学意义(P＜0.05).不吸烟组患者不同基因型中MAC Vm、ICA Vm差异无统计学意义(P＞0.05).吸烟组患者尿F2-异前列烷水平明显高于不吸烟组患者,差异有统计学意义(P＜0.05). 结论 内皮一氧化氮合酶基因型可改变吸烟的动脉瘤性蛛网膜下腔出血患者脑血液循环,使其脑血流速度增高.

Abstract：

Objective To study the effect ofT-786C polymorphism of endothelial NO synthase gene on cerebral circulation in smokers with aneurysmal subarachnoid hemorrhage. Methods Three hundred and ninety-four patients with aneurysmal subarachnoid hemorrhage were adopted in our study;smokers and nonsmokers were defined by 200 and 0, respectively, according to the smoking index (quantity of cigarettes per year). Transcranial color-coded Doppler (TCCD) was employed to detect the alterations of flow velocity of cerebral arteries. Genotyping ofT-786C was performed by using a newly developed allele-specific polymerase chain reaction. Degree of oxidative stress of these patients were evaluated by measuring the level of F2-isoprostane excretion in the urine. Results The mean flow velocity (Vm) of middle cerebral artery (MCA) and internal carotid artery (ICA) was obviously increased as compared with that of the other normal ones in most of the smokers. The Vm of MCA and ICA in nonsmokers was not obviously different as compared with the normal values. The 3 genotypes ofT-786C in smokers showed significant difference in Vm of MCA and ICA (P＜0.05); the Vm of CC genotype ([60.73±63.58] cm/s) was obviously increased as compared with that of TT ([95.8±53.5] cm/s) and TC ([93.6±51.6] cm/s) genotypes (P＜0.05). The 3 genotypes ofT-786C in nonsmokers did not show significant difference in Vm of MCA and ICA (P＞0.05). The level of F2-isoprostane excretion in smokers was significantly higher than that in nonsmokers (P＜0.05). Conclusion The T-786C polymorphism of endothelial NO synthase gene can increase cerebrovascular Vm by enhancing the cerebrovascular circulation of smokers with aneurysmal subarachnoid hemorrhage.     

颅内动脉瘤性蛛网膜下隙出血并发Takotsubo心肌病

目的探讨颅内动脉瘤性蛛网膜下隙出血并发Takotsubo心肌病临床特点。方法回顾分析14例颅内动脉瘤性蛛网膜下隙出血并发Takotsubo心肌病患者的临床资料、血清心肌酶谱[包括肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、氨基末端B型利尿钠肽前体(NT-pro BNP)]水平、心电图和超声心动图表现。结果 14例患者入院时(初次检查)血清心肌酶谱[CK(591.93±248.78)IU/L、CK-MB(27.07±7.66)IU/L、NT-pro BNP(8685.36±3963.44)IU/L]水平即升高,2周复查时下降[CK(137.79±29.93)IU/L、CK-MB(14.36±5.58)IU/L、NT-pro BNP(577.14±203.37)IU/L],治疗前后差异具有统计学意义(t=7.090,P=0.000;t=4.897,P=0.000;t=7.778,P=0.000)。入院时心电图表现为ST段抬高或压低、T波倒置、QT间期延长,超声心动图呈节段性左室壁运动异常,左心室射血分数(36.07±6.15)%,2周复查时升至(56.43±3.18)%(t=13.381,P=0.000),1个月后恢复正常。结论颅内动脉瘤性蛛网膜下隙出血可诱发Takotsubo心肌病,患病率约4.58%,患者预后良好。超声心动图对早期筛查至关重要,急性期可通过冠状动脉造影术明确诊断。