Stroke:可卡因增动脉瘤蛛网膜下腔出血患者院内死亡风险

　　美国一项研究表明，在动脉瘤蛛网膜下腔出血（aSAH）患者中，可卡因急性应用与动脉瘤再破裂和院内死亡风险升高相关。论文5月7日在线发表于《卒中》（Stroke）。

　　此项研究共纳入1134例aSAH患者。从中确定可卡因急性应用者，并与近期无可卡因暴露的患者加以比较；比较内容包括就诊表现、动脉瘤再破裂和迟发性脑缺血等并发症以及院内死亡率和功能转归等转归指标。

　　结果显示，共有142例（12.5%）患者与可卡因应用相关。可卡因应用者更为年轻的可能性较大（P<0.001）。两组患者在Hunt-Hess分级不佳、相关性脑室内出血和入院头颅CT脑积水发生率方面无显著差异。在可卡因应用者中动脉瘤破裂发生率较高（P<0.05）。对其他因素进行校正之后，可卡因应用与迟发型脑缺血风险较高无显著相关性。可卡因应用者的出院存活可能性低于非应用者；其院内死亡的校正机率升高2.9倍（P<0.001）。两组患者的功能转归无差异。

与蛛网膜相关的拓展阅读：

• Stroke：CT阴性、腰穿可疑蛛网膜下腔出血患者血管造影可获益
• Stroke：吸烟或为蛛网膜下腔出血后迟发性脑缺血原因
• [TISC 2012] 解读：最新动脉瘤性蛛网膜下腔出血指南 更多信息请点击：有关蛛网膜更多资讯

Impact of Acute Cocaine Use on Aneurysmal Subarachnoid Hemorrhage.
BACKGROUND AND PURPOSE
Acute cocaine use has been temporally associated with aneurysmal subarachnoid hemorrhage (aSAH). This study analyzes the impact of cocaine use on patient presentation, complications, and outcomes.
METHODS
Data of patients admitted with aSAH between 1991 and 2009 were reviewed to determine impact of acute cocaine use (C). These patients were compared with aSAH patients without recent cocaine exposure (NC) in relation to their presentation, complications such as aneurysmal rerupture and delayed cerebral ischemia, and outcomes including hospital mortality and functional outcome.
RESULTS
Data of 1134 aSAH patients were reviewed; 142 patients (12.5%) had associated cocaine use. Cocaine users were more likely to be younger (mean age: C, 49±11; NC, 53±14; P<0.001). There were no differences in rates of poor-grade Hunt and Hess (4-5); (C, 21%; NC, 26%; P>0.05), associated intraventricular hemorrhage (C, 56%; NC, 51%; P>0.05), or hydrocephalus on admission Head CT (C, 49%; NC, 52%; P>0.05). Aneurysm rerupture incidence was higher among cocaine users (C, 7.7%; NC, 2.7%; P<0.05). The association of cocaine use with higher risk of delayed cerebral ischemia (C, 22%; NC, 16%; P<0.05) was not significant after correcting for other factors. Cocaine users were less likely to survive hospitalization compared with nonusers (mortality: C, 26%; NC, 17%; P<0.05); the adjusted odds of hospital mortality were 2.9 times higher among cocaine users (P<0.001). There were no differences in functional outcomes between the 2 groups.
CONCLUSIONS
Acute cocaine use was associated with a higher risk of aneurysm rerupture and hospital mortality after aSAH.