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題 名 | Aneurysmal Subarachnoid Hemorrhage: Timing of Admission, and Delayed Factors=腦動脈瘤破裂引發的蜘蛛網膜下腔出血--住院時機與延遲因素之探討 |
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作 者 | 李石增; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 24:3 民80.05-06 |
頁 次 | 頁675-680 |
分類號 | 416.291 |
關鍵詞 | 腦動脈瘤破裂; 蜘蛛網膜下腔出血; |
語 文 | 英文(English) |
中文摘要 | 早期診斷與治療對於因為腦動脈瘤破裂引發的蜘蛛網膜下腔出血後的再出血及因腦血管痙孿而致腦缺血是非常重要的。本研究為了瞭解腦動脈瘤破裂後病患住院的時機,延遲的因素及治療的死亡率將1977年至1987年間於長庚紀念醫院615位證明為腦動脈瘤破裂之住院病患加以分析,其中未延遲組有176位(28.62%)病患於發病當天或24小時內即得到正確診斷並住院治療,而延遲組有439位(71.38%)病患於病發後因某些原因而未能於病發後一天內正確診斷,治療。二組病患之男,女比例及年齡分佈無顯著差異(P>0.05),住院前有多次出血而未被診斷出來的在延遲組較多(P<0.05)。最常見的延遲原因為診斷上的問題,有285位(46.34%);因病患本身忽略而致延遲的有52位佔8.46%。平均延遲住院日數為8.07±1.28天(平均值±標準差)。二組外科或內科治療的死亡率及住院期間再出血之比例於延遲組較佳(P<0.05),可能是受住院時神經學狀態於延遲組較佳(P<0.01)之影響。 我們希望日後醫界能加強大眾對此疾病的認知,及醫學生,醫師們對此病患的症候,診斷能有進一步的瞭解,以期達到早期診斷,治療來改善此一疾病的預後。 |
英文摘要 | Early diagnosis and treatment for aneurysmal subarachnoid hemorrhage (SAH) is important for minimizing rebleeding and ischemia due to vasospasm and achieving optimal results. The purpose of this study was to analyze the timing of admission, factors causing delayed admission and the overall mortality rate related to the current management of SAH due to the rupture of intracranial aneurysm. During the period of from 1977 through 1987, 615 cases with proven rupture aneurysm were studied. Of 176 (28.62%) patients who were admitted to the neurological or neurosurgical department on the same day (day 0) as the onset of aneurysmal SAH were classified as non-delayed (ND) group. Of 439 (71.38%) patients who were admitted later due to some factors were classified as delayed (D) group. The correlation of sex ratio and age distribution had no statistical significance between two groups. The neurological condition at admission was much better in the D group (P<0.01). Multiple hemorrhages prior to admission were also higher in the D group (P<0.05). The length of delay from onset of aneurysmal SAH to admission was 8.07±1.28(Mean±SE) days. The most common cause of delay was due to diagnostic problem which accounted for 285 (46.34%) patients. Failure to seek prompt medical care was found in 52 (8.46%) patients. The rebleeding rate during admission was higher in the ND group (P<0.05). The overall mortality rate was 34.15%. Non-surgically treated patients had higher mortality rates than surgically treated patients. The results favor both the surgically and non-surgically treated patients in D group (P<0.05), but the fact that the neurological condition at admission was better in D group was obvious. We hope that an increased awareness of the public, medical students and physicians to the signs and symptoms of SAH, and prompt therapies will ultimately lead to an increase of the number of patients who survive aneurysmal SAH with satisfactory outcome. |
本系統中英文摘要資訊取自各篇刊載內容。