Resultado del tratamiento de la hemorragia subaracnoidea debida a rotura de aneurismas cerebrales
Results of treatment of subarachnoid haemorrhage due to a ruptured cerebral aneurysm
Mª.I. González-Pérez
Servicio de Medicina Intensiva. Complejo Hospitalario de León
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Complejo Hospitalario de León" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia postal: Servicio de Medicina Intensiva del Complejo Hospitalario de León. Altos de Nava s/n. 24071 León." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Results of treatment of subarachnoid haemorrhage due to a ruptured cerebral aneurysm" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-10-18" "fechaAceptado" => "2005-11-20" "PalabrasClave" => array:2 [ "es" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec159396" "palabras" => array:4 [ 0 => "Hemorragia subaracnoidea" 1 => "Aneurisma" 2 => "Embolización" 3 => "Resultado" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abreviaturas" "identificador" => "xpalclavsec159398" "palabras" => array:4 [ 0 => "HSA" 1 => "ICU" 2 => "TAM" 3 => "UCI" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec159397" "palabras" => array:4 [ 0 => "Subarachnoid haemorrhage" 1 => "Aneurysm" 2 => "Embolization" 3 => "Result" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar a los pacientes con hemorragia subaracnoidea (HSA) aneurismática confirmada, en el Hospital de León, durante los años 2001 a 2003.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El protocolo de tratamiento incluye: traslado rápido al Centro de Referencia, control de la tensión arterial e infusión de nimodipino, arteriografía y tratamiento endovascular en las primeras 72 horas del ingreso. Si no es posible embolizar, cirugía lo más precoz posible. Manejo agresivo antiisquemia y utilización de doppler transcraneal para el diagnóstico y seguimiento del vasoespasmo.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Los 54 pacientes ingresados vivos con el diagnóstico principal de HSA se clasificaron según las escalas de Hunt-Hess y Fisher, al ingreso. El seguimiento se hizo hasta el alta del Hospital; analizando morbilidad (presencia de un déficit neurológico al alta, de cualquier grado, diferente a la parálisis de un par craneal) y la mortalidad. Se consideró estadísticamente significativa una p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Durante el periodo de estudio, el 86% de los pacientes que ingresaron con HSA lo hicieron en las 24 horas siguientes al sangrado. Cinco pacientes no fueron tratados por presentar HSA masiva con Hunt- Hess V, de los que fallecieron 4. En los 49 (90,74%) restantes la embolización se llevó a cabo con éxito en 28 (54%) y en 21 (38%) no se pudo realizar por las características del aneurisma; se operaron en las siguientes 72 horas.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Seis pacientes (16,8%) embolizados y 3 (14,2%) operados tuvieron secuelas neurológicas (p<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0,05). Fallecieron 3 (14,2%) enfermos con tratamiento endovascular y 4 (19%) quirúrgicos (p<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0,05).</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La frecuencia de vasoespasmo fue de un 20% y la de resangrado de un 16%.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La estancia en UCI de los pacientes embolizados fue de 6,1 días y la de los pacientes con tratamiento quirúrgico fue de 8,8. (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0 5).</p> <span class="elsevierStyleSectionTitle">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El tratamiento endovascular se puede realizar con éxito en más de la mitad de los pacientes. Hay relación entre el nivel de conciencia al ingreso y el pronóstico. No encontramos diferencias significativas, desde el punto de vista estadístico, en la morbi-mortalidad entre los pacientes embolizados y los intervenidos quirúrgicamente, pero sí en cuanto a la estancia en UCI (menor en los pacientes tratados por procedimiento endovascular).</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">This study was designed to evaluate patients with confirmed aneurismal SAH (subarachnoid haemorrhage) in León Hospital between 2001 and 2003.</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The treatment protocol includes: rapid transfer to the reference centre, blood pressure control and nimodipine infusion, arteriography and endovascular treatment within the first 72 hours after admission. Surgery is performed as soon as possible if embolization is not possible. Aggressive antiaeschemic handling and transcranial Doppler are used for diagnosis and vasospasm monitoring.</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The patients were classified on admission according to the Hunt-Hess scale. Monitoring continued until discharge, and morbidity (any degree of neurological deficiency on discharge, not paralysis of a cranial pair) and mortality were analysed. P<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 was considered statistically significant.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">During the study period 54 patients had SAH on admission, 86% of whom were admitted to Intensive Care Unit 24 hours after bleeding. Five patients were not treated as they had massive SAH with Hunt-Hess V. Four of them died. Of the remaining 49 patients (90.74%) embolization was successful in 28 (54%) but 21 (38%) were not embolized due to the characteristics of the aneurysm; they were operated on within the following 72 hours.</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Six embolized 16.8%) and 3 (14.2%) patients operated on had neurological sequelae (p<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05). Three endovascularly treated patients (14.2%) and 4 (19%) surgically treated died (p<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05). The frequency of clinical vasospasm was 20% an rebleeding occurred in 16%. The length of stay in the ICU of embolized patients was significantly shorter than the operated patients (6.1 vs 8.8)days, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05.</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The endovascular treatment can be successfully carried out in over half of the patients with ruptured aneurysms. There is a significant relationship between the degree of consciousness on admission and the prognosis. We found no statistically significant differences in morbid-mortality between the embolized patients and those undergoing conventional surgery. However, there was a difference in length of stay in the ICU (shorter in patients treated by endovascular coiling).</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">González-Pérez, Mª.I.: Resultado del tratamiento de la hemorragia subaracnoidea debida a rotura de aneurismas cerebrales. Neurocirugía 2006; 17: 433–439.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subarachnoid haemorrhage due to ruptured aneurysms. A simple method of estimating prognosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E.C. Alvord" 1 => "J.D. Loeser" 2 => "W.L. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Marzo | 3 | 2 | 5 |
| 2018 Febrero | 9 | 8 | 17 |
| 2018 Enero | 13 | 2 | 15 |
| 2017 Diciembre | 8 | 15 | 23 |
| 2017 Noviembre | 36 | 33 | 69 |
| 2017 Octubre | 9 | 4 | 13 |
| 2017 Septiembre | 20 | 9 | 29 |
| 2017 Agosto | 9 | 10 | 19 |
| 2017 Julio | 13 | 7 | 20 |
| 2017 Junio | 22 | 6 | 28 |
| 2017 Mayo | 22 | 7 | 29 |
| 2017 Abril | 9 | 6 | 15 |
| 2017 Marzo | 21 | 16 | 37 |
| 2017 Febrero | 6 | 5 | 11 |
| 2017 Enero | 9 | 8 | 17 |
| 2016 Diciembre | 27 | 23 | 50 |
| 2016 Noviembre | 24 | 14 | 38 |
| 2016 Octubre | 22 | 10 | 32 |
| 2016 Septiembre | 22 | 9 | 31 |
| 2016 Agosto | 41 | 15 | 56 |
| 2016 Julio | 30 | 11 | 41 |
| 2015 Diciembre | 3 | 0 | 3 |
| 2015 Septiembre | 1 | 0 | 1 |
| 2015 Julio | 2 | 4 | 6 |
| 2015 Junio | 11 | 8 | 19 |
| 2015 Mayo | 13 | 14 | 27 |
| 2015 Abril | 19 | 18 | 37 |
| 2015 Marzo | 19 | 15 | 34 |
| 2015 Febrero | 10 | 15 | 25 |
| 2015 Enero | 15 | 14 | 29 |
| 2014 Diciembre | 14 | 15 | 29 |
| 2014 Noviembre | 10 | 11 | 21 |
| 2014 Octubre | 18 | 17 | 35 |
| 2014 Septiembre | 14 | 20 | 34 |
| 2014 Agosto | 13 | 15 | 28 |
| 2014 Julio | 16 | 12 | 28 |
| 2014 Junio | 15 | 23 | 38 |
| 2014 Mayo | 48 | 26 | 74 |
| 2014 Abril | 41 | 16 | 57 |
| 2014 Marzo | 29 | 17 | 46 |
| 2014 Febrero | 15 | 19 | 34 |
| 2014 Enero | 11 | 23 | 34 |
| 2013 Diciembre | 20 | 18 | 38 |
| 2013 Noviembre | 18 | 18 | 36 |
| 2013 Octubre | 13 | 22 | 35 |
| 2013 Septiembre | 16 | 16 | 32 |
| 2013 Agosto | 25 | 22 | 47 |
| 2013 Julio | 22 | 12 | 34 |
| 2013 Junio | 12 | 13 | 25 |
| 2013 Mayo | 17 | 11 | 28 |
| 2013 Abril | 11 | 12 | 23 |
| 2013 Marzo | 10 | 20 | 30 |
| 2013 Febrero | 7 | 10 | 17 |
| 2013 Enero | 10 | 8 | 18 |
| 2012 Diciembre | 9 | 16 | 25 |
| 2012 Noviembre | 2 | 4 | 6 |
| 2012 Octubre | 0 | 3 | 3 |
| 2012 Septiembre | 0 | 3 | 3 |
| 2012 Enero | 15 | 0 | 15 |
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