Cardiac manifestations of subarachnoid hemorrhage

Subarachnoid hemorrhage (SAH) is a devastating condition. It carries a high mortality rate, with 12% of patients dying before reaching the hospital. Aside from its neurological morbidities, SAH is associated with significant medical complications. Cardiac manifestations are common and can impact morbidity and mortality in SAH patients. This article will discuss the cardiac manifestations of SAH.     

老年人蛛网膜下腔出血临床分析

目的总结老年人蛛网膜下腔出血(SAH)的临床特征、并发症和预后。方法回顾性分析132例老年人SAH的临床资料。结果56.8%患者以头痛为主要症状,43.2%出现头晕或眩晕,40.1%出现意识障碍,脑膜刺激征阴性比例为70.5%。病因以动脉瘤最常见。伴高血压者死亡率高。结论老年人SAH临床表现多样化,体征不明显,半数预后好,但死亡率高。     

Copeptin in aneurysmal subarachnoid hemorrhage

Copeptin is a peptide derived from pre-provasospression along with arginine vasospressin. In the setting of aneurysmal subarachnoid hemorrhage (SAH), elevated serum copeptin levels correlate with vasospasm, inpatient mortality, mortality at 1 year, and poor functional outcome at 1 year. The potential role of serum copeptin levels in the management of patients with aneurysmal SAH is promising and should be explored further.     

脑脊液置换治疗蛛网膜下腔出血临床研究的荟萃分析

目的:分析已有的多项临床对照实验是否能说明脑脊液置换比常规治疗在降低蛛网膜下腔出血(SAH)的病死率方面有更好的疗效。方法:用关键词途径搜索了Medline光盘数据库(1950-2005.2)和中国医院知识仓库(CHKD)中文期刊全文库(1994-2005.5),将观察对象是SAH患者、比较脑脊液置换和常规治疗疗效的所有临床对照研究论文数据作meta分析。结果:33项研究共2428例患者被纳入,合并效应量分析显示脑脊液置换组和常规治疗组病死率分别为5%(62/1240)和16%(191/1188),OR合并=0.28(95%CI 0.21-0.37),Z=8.54,P<0.01。结论:脑脊液置换可降低SAH患者病死率。     

Rebleeding in aneurysm after rectal enema: Re‐emphasis on careful subarachnoid hemorrhage management

Rebleeding in an aneurysmal subarachnoid hemorrhage (SAH) is catastrophic with high mortality and grave outcome. Meticulous management of SAH patients and the prevention of activities that might increase the chances of rebleeding are life‐saving.     

Management of subarachnoid hemorrhage

Spontaneous non-traumatic subarachnoid hemorrhage (SAH), caused by the intracranial aneurysm rupture, is a severe cerebrovascular emergency. Cerebral and extracerebral complications are frequently associated to SAH and increase significantly the morbidity and mortality. SAH is a severe medical condition in which outcome can be considerably influenced by an early aggressive expert care. Guidelines have been recently published and offer a framework for treatment of SAH patients. The intensivists’ role in the management of SAH victims is crucial and encompasses prompt diagnosis, identification, and treatment of intracranial (as hydrocephalus, intracranial hypertension, metabolic and electric disturbances, vasospasm and delayed cerebral ischemia) along with extracranial complications (mainly cardiovascular, respiratory, endocrine…).     

蛛网膜下腔出血并发低钠血症及预后分析

目的:探讨自发性蛛网膜下腔出血(SAH)急性期低钠血症的发生情况及其对预后的影响。方法:收集首次发病的急性期SAH病人76例,测定其血清钠,对发生低钠血症患者的预后及并发症进行分析。结果:SAH后低钠血症占同期自发性SAH的46.1%;并发低钠血症病人的死亡恶化率高于血钠正常的病人,有统计学意义(P﹤0.05),低钠血症患者发生血管痉挛及继发脑梗死、脑积水者也高于血钠正常者(P﹤0.05)。结论:SAH后低钠血症发生率很高;是预后差的危险因素;且与脑血管痉挛,脑积水关系密切。     

Emergency care of the patient with subarachnoid haemorrhage

Subarachnoid haemorrhage (SAH) is a devastating neurological disorder which frequently leads to serious neurological impairment and is associated with high mortality and morbidity. One in twenty patients who present to emergency care environments with SAH are misdiagnosed. The emergency care environment presents as a challenging setting for the management of the needs of those following SAH, requiring proactive, knowledgeable and holistic care to work effectively within a multidisciplinary context to achieve positive patient outcomes. This article highlights the key aspects of the nurse's role in caring of a patient with a subarachnoid haemorrhage.     

胎儿蛛网膜下腔出血产前超声诊断新方法

目的探讨胎儿蛛网膜下腔出血（SAH）的产前超声诊断策略与方法。 方法以2018年1月至2020年12月南方医科大学附属深圳市妇幼保健院就诊并经超声、磁共振检查确诊的5例SAH胎儿为研究对象,系统分析总结胎儿SAH的产前超声诊断方法及典型特征。 结果5例SAH胎儿产前超声声像图典型表现：（1）大脑外侧裂内均匀高回声5例。（2）额下沟、颞上沟、顶枕沟等表面脑沟回声均匀增强4例。（3）鞍上池、环池、帆间池等脑池内回声均匀增强3例。（4）前、后纵裂,矢状窦,窦汇周围回声增强2例。（5）脊髓圆锥周围蛛网膜下腔增厚强回声1例。（6）SAH出血灶合并颅内其他部位,引起脑实质或脑室内出血4例。（7）大脑中动脉血流峰值流速增高4例。（8）彩色多普勒血流成像显示出血灶内无血流信号5例。 结论胎儿SAH大脑外侧裂有典型均匀高回声表现,是产前超声发现并诊断胎儿SAH的重要线索,继续扫查大脑表面脑沟及脑池等有无均匀高回声表现以及寻找颅内及其他部位有无出血灶,是鉴别SAH有无合并其他颅内出血可靠的诊断思路。     

蛛网膜下隙出血患者水钠紊乱的影响因素及护理

目的探讨蛛网膜下隙出血(subarachnoid hemorrhage,SAH)患者水钠紊乱的影响因素及护理对策。方法回顾性分析并总结西安交通大学医学院第一附属医院2007年1月至2012年6月收治的183例SAH患者的临床资料。结果水钠紊乱多发生在SAH患者发病后的5~8d内,主要表现为低血钠,占85.5%。SAH患者水钠紊乱与Hunt-Hess分级、抗利尿激素分泌异常综合征(inappropriate antidiuretic hormone secretion,SIADH)、脑盐耗综合征(cerebral salt wasting syndrome,CSWS)及颅内压增高有关。结论护理人员应高度重视对SAH患者水钠代谢的持续监护,针对产生水钠紊乱的影响因素及早采取有效的护理对策,从而改善SAH患者的预后。     

The relationship between electrocardiographic abnormalities and location of the intracranial aneurysm in subarachnoid hemorrhage

The purpose of this study was to determine the value of the ECG in subarachnoid hemorrhage (SAH) in predicting poor outcome, and to define if specific ECG changes are related to the location of the aneurysm in SAH. A retrospective cohort study was performed on 97 patients with symptoms of SAH. An ECG and an initial computer tomograph (CT) scan were the two major inclusion criteria. The primary endpoint was in hospital mortality. ECG changes were correlated with mortality and severity of hemorrhage expressed as the Hijdra score. A prolonged QTc interval occurred more frequently in patients who had experienced a severe hemorrhage (RR = 3.18; 95% CI = 1.07-10.22; P < 0.05). LV hypertrophy criteria were strongly related to an aneurysm in the anterior communicating artery. U wave presence showed a statistically significant relationship with the posterior communicating artery and the middle cerebral artery. A prolonged QTc interval is observed more frequently in patients with severe hemorrhage. Specific ECG abnormalities were seen to be associated with the location of the aneurysm in the circle of Willis in SAH.     

卒中后的心肌缺血样损伤

目的　研究卒中后急性期心肌缺血样损伤的发生情况及对预后的影响。方法　以既往无心脏病史的卒中急性期患者为研究对象 ,发病 3d内及 15d后进行心电图 (ECG)检查 ,统计分析ECG出现缺血样改变的发生率及恢复率。以发病 3d内ECG出现缺血样改变患者为缺血组 ,ECG无明显异常者为对照组。统计分析死亡率差别。结果　蛛网膜下腔出血(SAH)后伴有ECG心肌缺血样表现的患者死亡率明显升高 (P <0 0 1)。脑梗死 (CI)或脑出血 (CH)伴有ECG心肌缺血样表现的患者死亡率无明显改变。存活患者中 ,这种ECG心肌缺血样改变短期内恢复的比率较低 ,且SAH的恢复率高于CH和CI(P<0 0 5 )。结论　急性卒中可导致心肌暂时性或长期性损伤 ,这种损伤可导致SAH患者死亡率升高     

蛛网膜下腔出血患者意识状态的分析

目的：分析影响蛛网膜下腔出血（ＳＡＨ）患者意识障碍的相关因素，为临床抢救提供依据。方法：回顾性分析１９８０～１９９５年收治的３９５例ＳＡＨ患者的临床资料。结果：本组３９５例ＳＡＨ，病后发生意识障碍者２２２例（５６．２０％），无意识障碍者１７３例。有、无意识障碍两组病例病程中发生脑疝者分别为３４．６８％和６．３６％，并发肺炎者分别为１１．６２％和２．３１％，并发消化道出血者分别为８．１０％和１．７３％。两组病死率分别为３４．６８％和８．６７％。脑动脉瘤破裂所致ＳＡＨ２２８例中意识障碍者１３９例（６０．９６％），非动脉瘤所致ＳＡＨ１６７例中有意识障碍者８３例（４９．７０％）。结论：观察ＳＡＨ患者有无意识障碍有助于对患者预后的分析判断，应尽早进行脑血管造影检查，如有脑动脉瘤则应争取尽早采取外科手术进行病因治疗。     

Arterial hypertension and coronary heart disease: clinical and functional aspects

The subjects of the study were 196 men with verified coronary heart disease (CHD). The subjects were divided into 4 groups: 1) patients without arterial hypertension (AH); 2) patients with mild AH, 3) patients with moderate AH, 4) patients with severe AH (SAH). All the patients were tested by means of veloergometry. The study found that the presence and severity of AH affected functional condition of cardiovascular system and clinical manifestations in patients with CHD. The appearance and aggravation of AH in CHD patients: 1) diminished clinical manifestations (angina), and elevated frequency of ECG signs of myocardial ischemia; there was significant growth of the proportion of patients with painless myocardial ischemia and ventricular arrhythmias associated with physical activity; 2) while causing moderate decrease of physical tolerance, substantially decreased the economy of cardiovascular system functioning, associated mostly with 'pressure overload"; pressor reaction effectiveness lowered; 3) worsened disturbances of recovery period, which manifested in prolongation of the time necessary for systolic pressure to return to initial level. These peculiarities were most prominent in patients with CHD and SAH, which allows considering this combination to be a new condition, requiring new approaches to evaluation of its clinical course and therapy.     

Microglia regulate blood clearance in subarachnoid hemorrhage by heme oxygenase-1

Subarachnoid hemorrhage (SAH) carries a 50% mortality rate. The extravasated erythrocytes that surround the brain contain heme, which, when released from damaged red blood cells, functions as a potent danger molecule that induces sterile tissue injury and organ dysfunction. Free heme is metabolized by heme oxygenase (HO), resulting in the generation of carbon monoxide (CO), a bioactive gas with potent immunomodulatory capabilities. Here, using a murine model of SAH, we demonstrated that expression of the inducible HO isoform (HO-1, encoded by Hmox1) in microglia is necessary to attenuate neuronal cell death, vasospasm, impaired cognitive function, and clearance of cerebral blood burden. Initiation of CO inhalation after SAH rescued the absence of microglial HO-1 and reduced injury by enhancing erythrophagocytosis. Evaluation of correlative human data revealed that patients with SAH have markedly higher HO-1 activity in cerebrospinal fluid (CSF) compared with that in patients with unruptured cerebral aneurysms. Furthermore, cisternal hematoma volume correlated with HO-1 activity and cytokine expression in the CSF of these patients. Collectively, we found that microglial HO-1 and the generation of CO are essential for effective elimination of blood and heme after SAH that otherwise leads to neuronal injury and cognitive dysfunction. Administration of CO may have potential as a therapeutic modality in patients with ruptured cerebral aneurysms.     

Capturing the full measure of patient outcome improvement using a self-assessed health adjustment

RATIONALE: Self-assessed health (SAH) status is a very simple four-, or five-category self-reported measure of health status that has been shown to be a powerful predictor of mortality, service use and total cost of medical care treatment. It is therefore reasonable to suggest that pre-intervention SAH may influence the extent to which patient outcomes improve following surgery. METHODS: Using the four-category measure of SAH of Excellent; Good; Fair; Poor, we developed an adjustment factor based on the mean improvement of the SAH category relative to the mean improvement of the overall sample. RESULTS: The results clearly indicate that the higher patients rated their pre-operative health, the greater their pre-post-operative improvement. Adjusting the outcome improvement by this SAH factor provides for the adjustment of the overall sample results by extent to which each category of SAH contributes to the overall mean. CONCLUSION: The results indicate that by adjusting patient outcome improvement measures by a factor based on pre-intervention SAH, overall sample patient outcome improvement increased 5.8%. The results also indicate that failure to adjust for pre-intervention SAH will result in an understatement of patient outcome improvement following surgery.     

原发性蛛网膜下腔出血502例临床分析

目的 总结原发性蛛网膜下腔出血(SAH)的临床特点、影像学特征、并发症和预后.方法 回顾性分析总结502例SAH患者的临床资料.结果 84.3%(423/496)患者以剧烈头痛为主要症状,13.1%(66/496)出现头晕或眩晕,意识障碍占27.5%(138/496),局灶性神经功能缺损体征58.2%(292/496),脑膜刺激征阳性72.5%(364/496),数字减影血管造影术检查阳性率54.1%(93/172),病因以动脉瘤最常见占20.1%(101/496).绝大部分预后好,老年人病死率高.结论 SAH病因复杂,临床表现多样化,脑血管造影常可明确病因,多数患者恢复良好.     

蛛网膜下腔出血的DSA和CT结果研究

研究蛛网膜下腔出血的数字减影血管造影和ＣＴ检查的价值。材料与方法：对８０例２４小时内ＣＴ检查和ＳＡＨ无颅内血肿的患者行ＤＳＡ检查。结果：一次ＳＡＨ患者脑动脉瘤３２例,正常２９例,１９例二次ＳＡＨ患者全部为脉其中１６例再次出血发生在发病后７－１８天。     

原发性蛛网膜下腔出血502例临床分析

目的 总结原发性蛛网膜下腔出血(SAH)的临床特点、影像学特征、并发症和预后.方法 回顾性分析总结502例SAH患者的临床资料.结果 84.3%(423/496)患者以剧烈头痛为主要症状,13.1%(66/496)出现头晕或眩晕,意识障碍占27.5%(138/496),局灶性神经功能缺损体征58.2%(292/496),脑膜刺激征阳性72.5%(364/496),数字减影血管造影术检查阳性率54.1%(93/172),病因以动脉瘤最常见占20.1%(101/496).绝大部分预后好,老年人病死率高.结论 SAH病因复杂,临床表现多样化,脑血管造影常可明确病因,多数患者恢复良好.     

Depressed sympathovagal balance predicts mortality in patients with subarachnoid hemorrhage

Objectives

The objective of this study is to investigate the role of sympathovagal balance in predicting inhospital mortality by assessing power spectral analysis of heart rate variability (HRV) among patients with nontraumatic subarachnoid hemorrhage (SAH) in an emergency department (ED).

Methods

A cohort of 132 adult patients with spontaneous SAH in an ED was prospectively enrolled. A continuous 10-minute electrocardiography for off-line power spectral analysis of the HRV was recorded. Using the inhospital mortality, the patients were classified into 2 groups: nonsurvivors (n = 38) and survivors (n = 94). The HRV measures were compared between these 2 groups of patients.

Results

Having compared the various measurements, the very low–frequency component, low-frequency component, normalized low-frequency component (LF%), and low-/high-frequency component ratio (LF/HF) were significantly lower, whereas the normalized high-frequency component was significantly higher among the nonsurvivors than among the survivors. A multiple logistic regression model identified LF/HF (odds ratio, 2.16; 95% confidence interval [CI], 1.18-3.97; P = .013) and LF% (odds ratio, 0.78; 95% CI, 0.69-0.88; P < .001) as independent variables that were able to predict inhospital mortality for patients with SAH in an ED. The receiver operating characteristic area for LF/HF in predicting inhospital mortality was 0.957 (95% CI, 0.914-1.000; P < .001), and the best cutoff points was 0.8 (sensitivity, 92.1%; specificity, 90.4%).

Conclusions

Power spectral analysis of the HRV is able to predict inhospital mortality for patients after SAH in an ED. A tilt in the sympathovagal balance toward depressed sympathovagal balance, as indicated by HRV analysis, might contribute to the poor outcome among these patients.