RESUMEN
Objective To investigate risk factors affecting prognosis in patients with poor-grade aneurysmal subarachnoid hemorrhage(aSAH) underwent surgical intervention. Methods From January 2015 to December 2017, 142 hospitalized patients with poor-grade (World Federation of Neurosurgery [WFNS] grade IV-V) a SAH were consecutively and retrospectively enrolled in the Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University. All patients were diagnosed as spontaneous subarachnoid hemorrhage by head CT with intracranial aneurysm confirmed by CT angiography (CTA) or DSA. According to different therapeutic interventions, 142 cases were divided into the surgical treatment group (65 cases) and the conservative treatment group (77 cases). Baseline demographics,clinical data,concomitant symptoms and complications were recorded and compared between groups. Baseline demographics included sex, age, smoking history, drinking history, hypertension and diabetes mellitus; clinical data included WFNS classification, Fisher classification, pupil changes, intracerebral hematoma, intraventricular hemorrhage,aneurysm location,aneurysm diameter; concomitant symptoms of aSAH included in-hospital rebleeding,symptomatic vasospasm,symptomatic hydrocephalus,epilepsy,pulmonary infection; treatment-related complications included recurrent bleeding after discharge, cerebral infarction and intracranial infection. Risk factors affecting prognosis in surgical patients were determined using univariate analysis and multivariate Logistic regression analysis. Results (1) Lower age and proportion of ventricular hematoma were found in the surgical treatment group than the conservative treatment group,and the differences were statistically significanti [54 ± 9] years old vs. [60±12] years old.i = 2. 947; 55.4 % [36/65] vs. 77. 9% [60/77] x2 e8. 175; all P 0. 05). (2) In the terms of aneurysm re-rupture, symptomatic vasospasm, symptomatic hydrocephalus,epilepsy and pulmonary infection,no significant differences were found between the surgical treatment group and the conservative treatment group (a l l P > 0. 05). No recurrent rebleeding after discharge happened in the surgical treatment group but 13.0% (10/77) in conservative treatment group. There was significant difference between the two groups (P 0. 01). (3) Higher proportion of patients with favorable prognosis and lower mortality rate were found in the surgical treatment group than the conservative treatment group, and the differences were statistically significant (favorable prognosis rate; 60. 0% [39/65] vs. 26. 0% [20/77], x2 = 16. 803, P 0. 05). (5) Age (from low to high) and pupil changes (with or without) were analyzed using multivariate Logistic regression with unfavorable prognosis of the surgical patients as dependent variables. The results showed that advanced age (Oft = 1. 067, 9 5 % CI I. 006 - 1. 147) was an independent risk factor for unfavorable prognosis in surgical patients with poor-grade a S A H (P < 0. 05). Conclusions Compared with conservative treatment, surgical patients with poor-grade a S A H have advantages in reducing recurrent bleeding after discharge but may increase the risk of cerebral infarction and intracranial infection. However,the overall prognosis of surgical patients is better. Advanced age is an independent risk factor for unfavorable prognosis of surgical patients with poor-grade aSAH.
RESUMEN
Objective@#To observe the clinical feasibility and security of SMT-Ⅱ video laryngoscope in difficult airway intubation in emergency department.@*Methods@#This study took 90 adults with difficult airway who were admitted to the rescue room of Jingxi court of Beijing Chao-Yang Hospital, Capital Medical University from January 2015 to December 2016.The patients were randomly divided into 2 groups(SMT-Ⅱ video laryngoscope group: n=45, Macintosh direct laryngoscope group: n=45), which were treated with endotracheal intubation and ventilator assisted ventilation.The evaluation of difficult mask ventilation(DMV) independent risk factor score, Wlison score, Cormack-Lehane grade, mouth opening, thyromental distance, visualization of the glottis, time for laryngoscopy, time for tracheal intubation, first-pass success rate of intubation, complications, mean arterial pressure(MAP) and heart rate(HR) before induction, after laryngoscopy, after induction, after intubation 5 minutes, 10 minutes were recorded.ANOVA, t-test, Chi-square test was used to analyze differences data, respectively.@*Results@#There was no significant difference between the two groups in terms of gender, age, height, weight and other general data, mouth opening, DMV independent risk factor score, Wlison score, and thyromental distance(χ2=0.045, t=-0.367, t=0.684, t=0.511, t=0.330, t=-0.724, t=1.219, t=1.034, all P>0.05). A Cormack-Lehane grade Ⅰ or Ⅱ view were 44 cases in SMT-Ⅱ video laryngoscope group and 14 cases in Macintosh direct laryngoscope group. It significantly improved with the use of SMT- Ⅱ video laryngoscope, compared with Macintosh direct laryngoscope(χ2=52.096, P<0.01). The time to best view was shorter in SMT-Ⅱ video laryngoscope group compared to that in Macintosh direct laryngoscope group with (15.0±1.0) seconds vs. (24.2±3.4) seconds(t=-26.319, P<0.05). The tube passage time was shorter with SMT-Ⅱ video laryngoscope (31.6±4.3) seconds vs. (12.7±0.9) seconds(t=-21.698, P<0.05)). The first -pass success rates in SMT-Ⅱ video laryngoscope group and Macintosh direct laryngoscope group were 100% and 84.4%, respectively(χ2=5.577, P<0.05). For complications, pharyngorrhagia at intubation occurred in 1 case in SMT-Ⅱ video laryngoscope group and 9 cases in Macintosh direct laryngoscope group(χ2=5.513, P<0.05), dislocation of tooth at intubation occurred in 0 case in SMT- Ⅱ video laryngoscope group and 6 cases in Macintosh direct laryngoscope group (χ2=4.464, P<0.05). The mean arterial pressure values before induction, after laryngoscopy, after induction and after intubation 5 minutes, 10 minutes were (84.8±3.3), (89.2±3.6), (90.8±3.6), (86.6±3.4), (85.4±3.6) mmHg(1 mmHg=0.133 kPa) in SMT-Ⅱ video laryngoscope group and (85.8±3.1), (91.9±3.4), (96.1±2.9), (90.0±2.5), (86.5±2.9) mmHg in Macintosh direct laryngoscope group. There was a significant difference between the two groups at the 5-time points of MAP (F=16.619, P=0.000). The heart rate values before induction, after laryngoscopy, after induction and after intubation 5 minutes, 10 minutes were(77.4±4.3), (80.8±4.3), (83.3±4.9), (78.8±4.2), (76.9±4.2) rate/minutes in SMT-Ⅱ video laryngoscope group and (75.7±4.0), (85.3±4.4), (90.7±4.4), (84.3±4.1), (78.3±4.2) rate/minutes in the Macintosh direct laryngoscope group.There was a significant difference between the two groups at the 5-time points of HR(F=15.857, P=0.000).@*Conclusions@#SMT-Ⅱ video laryngoscope uesd in difficult ariway enable better visualization of the glottic opening, short opertive time, enhance the success rate of intubation.It indicucates that SMT-Ⅱ video laryngoscope is safer than Macintosh direct laryngoscope in patients with difficult airway.