Relation Of Electrocardiographic Changes To Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Objective: Cerebral vasospasm(CVS) is one of the serious complicationsafter aneurysmal subarachnoid hemorrhage,and it’s an important cause ofmorbidity and mortality after aneurysmal subarachnoid hemorrhage,whichalso seriously affected zhe clinical outcome of patients. The pathogenesis ofvasospasm after SAH is still not definitively understood. One mechanism thatmay contribute to angiographic vasospasm is increased central sympatheticactivity, which is also thought to cause electrocardiographic (ECG) changesafter SAH. This study was designed by a retrospective analysis of therelationship between ECG as well as other clinical observations and cerebralvasospasm of aneurysmal subarachnoid hemorrhage, to filter out thesignificant associated risk factors,while observing the relation of ECG andCVS.Looking for methods to further reduce the incidence of CVS after aSAH,and improve patient outcomes.Methods: Collect the clinical data about the193patients withaneurysmal subarachnoid hemorrhage from June,2012to september,2013inNeurosurgery, Second Hospital of Hebei Medical University. Retrospectivelyanalysis the relationship between the early performance of electrocardiogramas well as other clinical and laboratory indexes, and cerebral vasospasm.Assessing patients with6-month follow-up results using the GOS score scale.Multivariate logistic regression was used to identify significant associations.Results:193patients met the study criteria,66patients occured cerebralvasospasm, the incidence rate is34.2%.128patients appeared different degreeof electrocardiogram abnormal performances. Through univariate andmultivariate Logistic regression analysis, QT prolongation is an independentrisk factor for CVS(OR=8.304,95%CI:3.624~19.025),other electrocardiogramabnormal performances are no statistically significant (P<0.05).At the same time,multivariate logistic regression analysis also showed that: with smokinghistory(OR=5.743,95%CI:2.373~13.897),hyponatremia(OR=2.038,95%CI:1.065~3.902), WFNS grade≧Ⅳ garde (OR=2.820,95%CI:1.204~6.604), Fishergrade≧3grade(OR=3.369,95%CI:1.372~8.271) regression coefficient(B)>O, OR>1,indicates an independent risk factor for CVS(P<0.05).The whiteblood cell count and surgical timing are also risk factors for cerebralvasospasm occurred. Judge patients with six month following-up, a total of33(17.1%) cases of death and severe disability in patients with a total of32(16.6%) cases, calculate after grouping, the results show that the patientswho had occurred CVS would have an increased morbidity and mortality(P<0.05).Conclusions:1The QT prolongation at early ECG is an independent riskfactor for CVS,the incidence of CVS in patients with QT prolongation isincreasing.2Smoking, hyponatremia, WFNS grade≧Ⅳ garde, Fisher grade≧3grade were independent risk factors for angiographic vasospasm afteraneurysmal subarachnoid hemorrhage.,which should be closely monitored,positive prevention and treatment. The white blood cell count is also a riskfactors for cerebral vasospasm occurred, detecting the patient’s white bloodcell count can help early diagnosis and treatment of cerebral vasospasm.3Optimal timing of surgery of aneurysmal subarachnoid hemorrhage isbleeding after three days.4Patients who had occurred cerebral vasospasmwith poor prognosis and increasing mortality and morbidity, should be givenearly aggressive treatment.