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首页> 外文期刊>Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia >In-hospital outcomes of aneurysmal subarachnoid hemorrhage associated with cocaine use in the USA
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In-hospital outcomes of aneurysmal subarachnoid hemorrhage associated with cocaine use in the USA

机译：美国可卡因使用引起的动脉瘤性蛛网膜下腔出血的院内预后

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Cocaine use is associated with higher mortality in small retrospective studies of brain-injured patients. We aimed to explore in-hospital outcomes in a large population based study of aneurysmal subarachnoid hemorrhage (aSAH) with cocaine use. aSAH patients were identified from the 2007-2010 USA Nationwide Inpatient Sample using International Classification of Disease, Ninth Revision codes. Demographics, comorbidities and surgical procedures were compared between cocaine users and non-users. The primary outcomes were in-hospital mortality and home discharge/self-care. Secondary outcomes were vasospasm treated with angioplasty, hydrocephalus, gastrostomy and tracheostomy. There were 103,876 patients with aSAH. The cocaine group were younger (45.8 +/- 9.8 versus 58.4 +/- 15.8, p < 0.001), predominantly male (53.3% versus 38.5%, p < 0.001) and had a higher proportion of black patients (36.9% versus 11.5%, p < 0.001). The incidence of seizures was higher among cocaine users (16.2% versus 11.1%, p < 0.001). Endovascular coiling of intracranial aneurysms (24% versus 18.5%, p < 0.001) was more frequent in cocaine users. The univariate analysis showed higher rates of in-hospital mortality and vasospasm treated with angioplasty, but lower home discharge in the cocaine group. In the multivariate analysis, the cocaine cohort had higher in-hospital mortality (odds ratio [OR] 1.43, 95% confidence interval [CI] 1.27-1.61, p < 0.001) and lower home discharge rates (OR 0.79, 95% CI 0.69-0.87, p < 0.001) after adjusting for confounders. Rates of vasospasm treated with angioplasty however were similar between the two groups. Cocaine use was found to be independently associated with poor outcomes, particularly higher mortality and lower home discharge rates. Cocaine use however, was not associated with vasospasm that required treatment with angioplasty. Prospective confirmation is warranted. (C) 2014 Elsevier Ltd. All rights reserved.
机译：在脑损伤患者的小型回顾性研究中，可卡因的使用与较高的死亡率相关。我们的目标是在可卡因使用的大动脉瘤性蛛网膜下腔出血（aSAH）的大型人群研究中探索院内结局。使用国际疾病分类（第九修订版）从2007-2010美国全国住院患者样本中鉴定aSAH患者。比较了可卡因使用者和非使用者中的人口统计学，合并症和手术程序。主要结果是院内死亡率和家庭出院/自我护理。次要结局为血管成形术，脑积水，胃造口术和气管切开术治疗的血管痉挛。有103,876例aSAH患者。可卡因组较年轻（45.8 +/- 9.8对58.4 +/- 15.8，p <0.001），主要是男性（53.3％对38.5％，p <0.001），黑人患者比例更高（36.9％对11.5％） ，p <0.001）。可卡因使用者的癫痫发作发生率更高（16.2％比11.1％，p <0.001）。可卡因使用者颅内动脉瘤的血管内盘绕（24％比18.5％，p <0.001）更为常见。单因素分析显示，通过血管成形术治疗的院内死亡率和血管痉挛发生率较高，但可卡因组的家庭出院率较低。在多变量分析中，可卡因人群的院内死亡率较高（赔率[OR] 1.43，95％置信区间[CI] 1.27-1.61，p <0.001），家庭出院率较低（OR 0.79，95％CI 0.69） -0.87，p <0.001）。两组之间血管痉挛的发生率相似。发现可卡因的使用与不良结局独立相关，特别是死亡率较高和出院率较低。然而，可卡因的使用与需要进行血管成形术治疗的血管痉挛无关。事先确认是必要的。 （C）2014 Elsevier Ltd.保留所有权利。

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