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ANALYSIS OF THE MORTALITY RATE IN PATIENTS WITH NON-TRAUMATIC SUBARACHNOID HEMORRHAGE. PREDISPOSING FACTORS, CAUSES, AND COMPLICATIONS


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Abstract

Subarachnoid hemorrhage (SAН) is an emergency condition with a 1-month mortality rate of up to 25% and disability to 50% of surviving patients. The main cause of the delayed neurological deficit is vasospasm, whose therapy is determined in the AHA / ASA treatment protocols (2009 and 2012 versions). The latter protocol is aimed at maintaining the physiological parameters of the circulating volume and hemodynamics instead of the hyperdynamic 3-H therapy. The purpose of the study is to compare the results of treatment according to both protocol taking into account the mortality rate and complications. Material and methods. A retrospective study of case histories of deceased patients with SAH hospitalized in the neurosurgical clinic of Hospital No. 40 in Yekaterinburg over the period from 2009 until 2012. A total of 380 patients with SAH underwent treatment, including 193 patients under the AHA / ASA 2012 (group A) protocol and 187 patients according to the 2009 protocol (group B). Results. The groups were comparable in the age and the severity of SAH. The incidence of SAH relapses was insignificantly higher in group A (53.6%) than in group B (31.3%). The average stay in the ICU was the similar in both groups and was equal to 7.5 days (5.36; 10) in group A and 9 days (7; 11) in group B. The mortality rate in group A was significantly lower and amounted to 14.5%; in group B, it was 23% (p = 0.034). The following extracerebral complications were found: acute lung injury syndrome; acute respiratory distress syndrome, pneumonia, pulmonary artery thromboembolism, catheter-associated bloodstream infections. Their frequency did not demonstrate intergroup differences, according to autopsy findings. Cerebral complications in the form of a progressive ischemia were significantly more common in group B (100%) as compared to 81.8% in group A (p = 0.015). Therefore, the use of the 2012 AHA/ASA protocol for the treatment of SAH aimed at maintaining euvolemia allows to reduce the mortality rate without changing the frequency of complications.


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