蛛网膜下腔出血后感染并发症的危险因素_王宁教程文件.ppt

蛛网膜下腔出血后感染并发症的危险因素Infectious complications of aneurysmal SAH 王 宁 首都医科大学宣武医院神经外科ICU 2009-06-21 目录 动脉瘤破裂造成的临床级联反应 感染性并发症的危险因素及对预后的影响 肺炎在肺部并发症的状况？ 肺部并发症的预防与控制 动脉瘤破裂造成的临床级联反应 A higher mortality and morbidity disease The mortality rate for SAH in the 1966 Cooperative Study on Intracranial Aneurysms was 50% at 29 days 33% in a recent analysis of in-hospital deaths among SAH patients admitted through an emergency department The factors that strongly influenceoutcome after SAH Patient factors: the severity of initial hemorrhage, age, sex, time to treatment, and medical co-morbidities such as untreated and treated hypertension, atrial fibrillation, congestive heart failure, coronary artery disease, and renal disease. Aneurysm factors: size, location in the posterior circulation, and possibly morphology. Institutional factors include the availability of endovascular services, the volume of SAH patients treated, and the type of facility in which the patient is first evaluated. Cross DT. Mortality rates after subarachnoid hemorrhage: variations according to hospital case volume in 18 states. J Neurosurg.2003;99:810–817. Vasospasm Angiographic vasospasm is seen in 30% to 70% of patients In contemporary series, 15% to 20% of such patients suffer stroke or die of vasospasm despite maximal therapy Looked at another way, vasospasm appears to account for nearly 50% of the deaths in patients surviving to treatment after SAH Longstreth WT. Clinical course of spontaneous subarachnoid hemorrhage: a population-based study in King County, Washington. Neurology. 1993;43:712–718. Hydrocephalus Acute hydrocephalus (ventricular enlargement within 72 hours) is reported to occur in 20% to 30% of patients. Chronic ventriculomegaly requiring permanent shunting procedures is reported at rates of 18% to 26% of surviving patients. Seizures More recent retrospective reviews report a low frequency of seizures ranging from 6% to18%. Delayed seizures occurred in 7% of patients in