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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar a los pacientes con hemorragia subaracnoidea &#40;HSA&#41; aneurism&#225;tica confirmada&#44; en el Hospital de Le&#243;n&#44; durante los a&#241;os 2001 a 2003&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El protocolo de tratamiento incluye&#58; traslado r&#225;pido al Centro de Referencia&#44; control de la tensi&#243;n arterial e infusi&#243;n de nimodipino&#44; arteriograf&#237;a y tratamiento endovascular en las primeras 72 horas del ingreso&#46; Si no es posible embolizar&#44; cirug&#237;a lo m&#225;s precoz posible&#46; Manejo agresivo antiisquemia y utilizaci&#243;n de doppler transcraneal para el diagn&#243;stico y seguimiento del vasoespasmo&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Los 54 pacientes ingresados vivos con el diagn&#243;stico principal de HSA se clasificaron seg&#250;n las escalas de Hunt-Hess y Fisher&#44; al ingreso&#46; El seguimiento se hizo hasta el alta del Hospital&#59; analizando morbilidad &#40;presencia de un d&#233;ficit neurol&#243;gico al alta&#44; de cualquier grado&#44; diferente a la par&#225;lisis de un par craneal&#41; y la mortalidad&#46; Se consider&#243; estad&#237;sticamente significativa una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Durante el periodo de estudio&#44; el 86&#37; de los pacientes que ingresaron con HSA lo hicieron en las 24 horas siguientes al sangrado&#46; Cinco pacientes no fueron tratados por presentar HSA masiva con Hunt- Hess V&#44; de los que fallecieron 4&#46; En los 49 &#40;90&#44;74&#37;&#41; restantes la embolizaci&#243;n se llev&#243; a cabo con &#233;xito en 28 &#40;54&#37;&#41; y en 21 &#40;38&#37;&#41; no se pudo realizar por las caracter&#237;sticas del aneurisma&#59; se operaron en las siguientes 72 horas&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Seis pacientes &#40;16&#44;8&#37;&#41; embolizados y 3 &#40;14&#44;2&#37;&#41; operados tuvieron secuelas neurol&#243;gicas &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Fallecieron 3 &#40;14&#44;2&#37;&#41; enfermos con tratamiento endovascular y 4 &#40;19&#37;&#41; quir&#250;rgicos &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La frecuencia de vasoespasmo fue de un 20&#37; y la de resangrado de un 16&#37;&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La estancia en UCI de los pacientes embolizados fue de 6&#44;1 d&#237;as y la de los pacientes con tratamiento quir&#250;rgico fue de 8&#44;8&#46; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0 5&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El tratamiento endovascular se puede realizar con &#233;xito en m&#225;s de la mitad de los pacientes&#46; Hay relaci&#243;n entre el nivel de conciencia al ingreso y el pron&#243;stico&#46; No encontramos diferencias significativas&#44; desde el punto de vista estad&#237;stico&#44; en la morbi-mortalidad entre los pacientes embolizados y los intervenidos quir&#250;rgicamente&#44; pero s&#237; en cuanto a la estancia en UCI &#40;menor en los pacientes tratados por procedimiento endovascular&#41;&#46;</p>"
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        "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 &#40;subarachnoid haemorrhage&#41; in Le&#243;n Hospital between 2001 and 2003&#46;</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The treatment protocol includes&#58; rapid transfer to the reference centre&#44; blood pressure control and nimodipine infusion&#44; arteriography and endovascular treatment within the first 72 hours after admission&#46; Surgery is performed as soon as possible if embolization is not possible&#46; Aggressive antiaeschemic handling and transcranial Doppler are used for diagnosis and vasospasm monitoring&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The patients were classified on admission according to the Hunt-Hess scale&#46; Monitoring continued until discharge&#44; and morbidity &#40;any degree of neurological deficiency on discharge&#44; not paralysis of a cranial pair&#41; and mortality were analysed&#46; P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered statistically significant&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">During the study period 54 patients had SAH on admission&#44; 86&#37; of whom were admitted to Intensive Care Unit 24 hours after bleeding&#46; Five patients were not treated as they had massive SAH with Hunt-Hess V&#46; Four of them died&#46; Of the remaining 49 patients &#40;90&#46;74&#37;&#41; embolization was successful in 28 &#40;54&#37;&#41; but 21 &#40;38&#37;&#41; were not embolized due to the characteristics of the aneurysm&#59; they were operated on within the following 72 hours&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Six embolized 16&#46;8&#37;&#41; and 3 &#40;14&#46;2&#37;&#41; patients operated on had neurological sequelae &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Three endovascularly treated patients &#40;14&#46;2&#37;&#41; and 4 &#40;19&#37;&#41; surgically treated died &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The frequency of clinical vasospasm was 20&#37; an rebleeding occurred in 16&#37;&#46; The length of stay in the ICU of embolized patients was significantly shorter than the operated patients &#40;6&#46;1 vs 8&#46;8&#41;days&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</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&#46; There is a significant relationship between the degree of consciousness on admission and the prognosis&#46; We found no statistically significant differences in morbid-mortality between the embolized patients and those undergoing conventional surgery&#46; However&#44; there was a difference in length of stay in the ICU &#40;shorter in patients treated by endovascular coiling&#41;&#46;</p>"
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Vol. 17. Núm. 5.
Páginas 433-439 (enero 2005)
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Vol. 17. Núm. 5.
Páginas 433-439 (enero 2005)
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
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Mª.I. González-Pérez
Servicio de Medicina Intensiva. Complejo Hospitalario de León
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Resumen
Objetivo

Evaluar a los pacientes con hemorragia subaracnoidea (HSA) aneurismática confirmada, en el Hospital de León, durante los años 2001 a 2003.

Material y métodos

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.

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<0.05.

Resultados

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.

Seis pacientes (16,8%) embolizados y 3 (14,2%) operados tuvieron secuelas neurológicas (p>0,05). Fallecieron 3 (14,2%) enfermos con tratamiento endovascular y 4 (19%) quirúrgicos (p>0,05).

La frecuencia de vasoespasmo fue de un 20% y la de resangrado de un 16%.

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<0.0 5).

Conclusión

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).

Palabras clave:
Hemorragia subaracnoidea
Aneurisma
Embolización
Resultado
Abreviaturas:
HSA
ICU
TAM
UCI
Summary
Objective

This study was designed to evaluate patients with confirmed aneurismal SAH (subarachnoid haemorrhage) in León Hospital between 2001 and 2003.

Materials and methods

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.

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<0.05 was considered statistically significant.

Results

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.

Six embolized 16.8%) and 3 (14.2%) patients operated on had neurological sequelae (p>0.05). Three endovascularly treated patients (14.2%) and 4 (19%) surgically treated died (p>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<0.05.

Conclusion

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).

Key words:
Subarachnoid haemorrhage
Aneurysm
Embolization
Result

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