蛛网膜下腔出血后感染并发症的危险因素VIP免费

蛛网膜下腔出血后感染并发症的危险因素InfectiouscomplicationsofaneurysmalSAH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AhighermortalityandmorbiditydiseaseThemortalityrateforSAHinthe1966CooperativeStudyonIntracranialAneurysmswas50%at29days33%inarecentanalysisofin-hospitaldeathsamongSAHpatientsadmittedthroughanemergencydepartmentNaturehistoryIntheprospectiveCooperativeAneurysmStudy,rebleedingwasmaximal(4%)onthefirstdayafterSAHandthenconstantatarateof1%perdayto2%perdayoverthesubsequent4weeks.Severalprospectivefollow-upcohortshavedemonstratedthattheriskofrebleedingwithconservativetherapyisbetween20%and30%forthefirstmonthafterhemorrhageandthenstabilizesatarateof3%peryear.并发症是影响预后的重要因素ThefactorsthatstronglyinfluenceoutcomeafterSAHPatientfactors:theseverityofinitialhemorrhage,age,sex,timetotreatment,andmedicalco-morbiditiessuchasuntreatedandtreatedhypertension,atrialfibrillation,congestiveheartfailure,coronaryarterydisease,andrenaldisease.Aneurysmfactors:size,locationintheposteriorcirculation,andpossiblymorphology.Institutionalfactorsincludetheavailabilityofendovascularservices,thevolumeofSAHpatientstreated,andthetypeoffacilityinwhichthepatientisfirstevaluated.CrossDT.Mortalityratesaftersubarachnoidhemorrhage:variationsaccordingtohospitalcasevolumein18states.JNeurosurg.2003;99:810–817.VasospasmAngiographicvasospasmisseenin30%to70%ofpatientsIncontemporaryseries,15%to20%ofsuchpatientssufferstrokeordieofvasospasmdespitemaximaltherapyLookedatanotherway,vasospasmappearstoaccountfornearly50%ofthedeathsinpatientssurvivingtotreatmentafterSAHLongstrethWT.Clinicalcourseofspontaneoussubarachnoidhemorrhage:apopulation-basedstudyinKingCounty,Washington.Neurology.1993;43:712–718.HydrocephalusAcutehydrocephalus(ventricularenlargementwithin72hours)isreportedtooccurin20%to30%ofpatients.Chronicventriculomegalyrequiringpermanentshuntingproceduresisreportedatratesof18%to26%ofsurvivingpatients.SeizuresMorerecentretrospectivereviewsreportalowfrequencyofseizuresrangingfrom6%to18%.Delayedseizuresoccurredin7%ofpatientsinanotherseries.BalanceofwaterandelectrolytesThereportedincidenceofhyponatremiaafterSAHrangesfrom10%to30%.感染性并发症的危险因素及对预后的影响两种手术方式治疗动脉瘤并发症分布治疗方式脑积水(n％)脑梗死(n％)脑内血肿(n％)癫痫(n％)肺炎(n％)消化道出血(n％)心血管(n％)手术治疗(n=99)5（5.05）4（4.04）4（4.04）2（2.02）15（15.15）3（3.03）3（3.03）栓塞治疗(n=128)6（4.68）7（5.46）2（1.56）06（4.69）1（0.78）0χ20.0160.2471.3322.6097.2811.6313.931P0.8990.6190.2480.1060.0070.2020.0472005~2008年ICU各类感染构成（n=226）162,72%19,8%18,8%8,4%5,2%5,2%4,2%4,2%1,0%下呼吸道感染泌尿系统其它汇总血液系统胸膜腔上呼吸道感染消化系统及腹部手术部位皮肤与软组织普外科感染与神外ICU感染部位比较95905635331276162419581851020406080100120140160180普通外科神经外科ICUWartenberg,KatjaE.IMPACTOFNOSOCOMIALINFECTIOUSCOMPLICATIONSAFTERSUBARACHNOIDHEMORRHAGE.Neurosurgery.200862(1),80–87SAH与NICU感染并发症发生率SAH（n=537）NICU肺炎114(20%)2-13%泌尿系感染77(13%)3-9%血液感染48(8%)1-2%脑室炎28(5%)1-9%Wartenberg,KatjaE.IMPACTOFNOSOCOMIALINFECTIOUSCOMPLICATIONSAFTERSUBARACHNOIDHEMORRHAGE.Neurosurgery.200862(1),80–87神经原性肺水肿（Neurogenicpulmonaryedema）TheincidenceofNPEwas8%(39of47...