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1、蛛网膜下腔出血后感染并发症的危险因素InfectiouscomplicationsofaneurysmalSAH王宁首都医科大学宣武医院神经外科ICU2009-06-21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AhighermortalityandmorbiditydiseaseThemortalityrateforSAHinthe1966CooperativeStudyonIntracranialAneurysmswas50%at29days33%ina
2、recentanalysisofin-hospitaldeathsamongSAHpatientsadmittedthroughanemergencydepartmentNaturehistoryIntheprospectiveCooperativeAneurysmStudy,rebleedingwasmaximal(4%)onthefirstdayafterSAHandthenconstantatarateof1%perdayto2%perdayoverthesubsequent4weeks.Severalprospectivefollow-upcoho
3、rtshavedemonstratedthattheriskofrebleedingwithconservativetherapyisbetween20%and30%forthefirstmonthafterhemorrhageandthenstabilizesatarateof3%peryear.并发症是影响预后的重要因素Thefactorsthatstronglyinfluence outcomeafterSAHPatientfactors:theseverityofinitialhemorrhage,age,sex,timetotreatment,a
4、ndmedicalco-morbiditiessuchasuntreatedandtreatedhypertension,atrialfibrillation,congestiveheartfailure,coronaryarterydisease,andrenaldisease.Aneurysmfactors:size,locationintheposteriorcirculation,andpossiblymorphology.Institutionalfactorsincludetheavailabilityofendovascularservice
5、s,thevolumeofSAHpatientstreated,andthetypeoffacilityinwhichthepatientisfirstevaluated.CrossDT.Mortalityratesaftersubarachnoidhemorrhage:variationsaccordingtohospitalcasevolumein18states.JNeurosurg.2003;99:810–817.VasospasmAngiographicvasospasmisseenin30%to70%ofpatientsIncontempora
6、ryseries,15%to20%ofsuchpatientssufferstrokeordieofvasospasmdespitemaximaltherapyLookedatanotherway,vasospasmappearstoaccountfornearly50%ofthedeathsinpatientssurvivingtotreatmentafterSAHLongstrethWT.Clinicalcourseofspontaneoussubarachnoidhemorrhage:apopulation-basedstudyinKingCount
7、y,Washington.Neurology.1993;43:712–718.HydrocephalusAcutehydrocephalus(ventricularenlargementwithin72hours)isreportedtooccurin20%to30%ofpatients.Chronicventriculomegalyrequiringpermanentshuntingproceduresisreportedatratesof18%to26%ofsurvivingpatients.SeizuresMorerecentretrospectiv
8、ereviewsreportalowfrequencyofseiz
