뇌동맥류성 지주막하출혈 환자에서 증상적 혈관 연축과 예후에 관여하는 요소들에 대한 분석

Abstract

Symptomatic vasospasm is still one of the major causes of death and disability in patients who suffer an aneurysmal subarachnoid hemorrhage(SAH). To identify risk factors related to symptomatic vasospasm, to determine the outcome in patients with SAH, and to determine the differences identified risk factors between patients with good and bad outcomes, we performed this retrospective study. From a total of 279 SAH patients who were admitted to our hospital between January 1993 and December 1995, 212 were chosen for study. These were patients who had been admitted within 7 days of SAH, had undergone brain computed tomography(CT) within 3 days of SAH and had survived more than 6 days after SAH. Nine variables were examined as to their relationship to symptomatic vasospasm：age, sex, admission day after SAH, hypertension history, frequency of SAH, clinical grade, CT grade, operation day after SAH, and outcome. Data were analyzed by the univariate and multivariate logistic regression method using the Statistical Analysis System(SAS). Symptomatic vasospasm was demonstrated in 30 cases(14.2%). Univariate analysis showed that admission more than 4 days after SAH(p=0.07), clinical grades Ⅲ-Ⅴ(p=0.001), and CT grade Ⅲ(p=0.00001) were associated with a higher risk of symptomatic vasospasm. When study cases were grouped into either good or bad outcome groups, and multivariate logistic regression analysis was performed, these factors were associated with a higher risk of symptomatic vasospasm only in the good outcome group. This suggests that there is a group of patients with a predisposition to symptomatic vasospasm that is independent of these risk factors, and that in these patients, the outcome may be worse.