| Objective: This clinical study through the aneurysmal subarachnoid hemorrhage(a SAH)patients arterial blood lactate levels change detection,comparison of aneurismal subarachnoid hemorrhage patients with normal concentrations of arterial blood lactate quantity difference,analysis of aneurismal subarachnoid hemorrhage patients’ arterial blood lactate content change over time;analysis the relationships between blood lactate and Hunt-Hess grade,Fisher CT grading scale and Glasgow Outcome Scale,discuss its value as a marker of disease severity and predict outcome.Methods: Eighty-six patients with acute a SAH were selected in the study,they were chosen from the department of neurosurgery of Second Hospital Affiliated to University of South China during September 2015 to September 2016.The reference value of normal arterial blood lactate were used as the standard control.Arterial blood samples were routinely collected from the radial artery on admission,immediately after microsurgery and 1,3,5 days after microsurgery,the concentration of blood lactate were analyzed by automatic blood gas analyzer immediately after collection.Date collected included demographics,Hunt-Hess grade,Fisher grade,location of aneurysms and previous medical history,within 24 h or 72 h after admission the patients were treated via microsurgery clipping.Subjects were follow until death or the completion of 6 months following a SAH,and were divided into favorable outcomes group(GOS 1-3)and unfavorable outcomes group(GOS 4-5)according to Glasgow Outcome Scale(GOS).Statistical methods spss22.0 statistical package was used to analyze date,measurement date with(x ± s),according to comparison between the two groups using “t” test;count date with(%),comparison between two groups using chi-square test;correlation analysis,the continuous variables using the Pearson correlation coefficient,the discontinuous variables using the spearman correlation coefficient,the factors influencing prognosis assessment using binary classification logistic regression analysis,α=0.05 as the inspection standard,if the P < 0.05 was statistically significant.Results: 1.Aneurysmal subarachnoid hemorrhage patient’s arterial blood lactate concentrations higher than the standard control;increased lactate levels reached maximum levels on admission and then decreased,but still beyond the normal range,then the levels slightly increased again on the first day after surgery.2.There were significant positive correlation between a SAH patients lactate levels and Hunt-Hess grade(p<0.05).There were significant positive correlation between a SAH patient’s lactate levels and Fisher grade on admission,immediately after microsurgery,and the first day after microsurgery(p<0.05),while on the 3,5 days after microsurgery the correlation were not significant(p>0.05).The blood lactate levels of Hunt-Hess Ⅳ ~ Ⅴ group was significantly higher than Hunt-HessⅠ ~ Ⅲ group,on admission,immediately after microsurgery,and 1,3 days after microsurgery(p<0.05),but there was no statistically significant difference on 5 days after microsurgery(p>0.05).The blood lactate levels of Fisher 3~4 group was significantly higher than Fisher 1 ~ 2 group,on admission,immediately after microsurgery,and 1,5 days after microsurgery(p<0.05),but there was no statistically significant difference on 3 days after microsurgery(p > 0.05).3.Favorable outcomes group 58 cases,unfavorable outcomes group 28 cases,there were no difference statistically in patient’s gender,age,past hypertension,past coronary atherosclerotic heart disease,past diabetes and locations of aneurysm between two groups(p>0.05).There were difference statistically in patient’s Hunt-Hess grade and Fisher grade between two groups,Hunt-Hess Ⅳ~Ⅴ group and Fisher 3~4 group had poor outcome than Hunt-Hess Ⅰ~Ⅲ group and Fisher 1~2 group(p<0.05).4.There were significant negative correlation between a SAH patient’s lactate levels and GOS score on admission,immediately after microsurgery,and 1,3 days after microsurgery(p < 0.05),while on the 5 day after microsurgery the correlation were not significant(p = 0.050).Blood lactate levels on admission,immediately after microsurgery and 1,3 days after microsurgery in the unfavorable outcomes group was significantly higher than the favorable outcomes group(3.20±1.54,1.98±1.11,2.28±1.58,1.73±1.23 vs.1.97±1.42,1.24±0.86,1.36±0.90,1.14±0.50,P<0.05)while on 5 day after microsurgery had no statistically significant difference(1.50±0.53 vs.1.26±0.53,p=0.056 > 0.05).5.In binary logistic regression analysis,Hunt-Hess grade(odds radio=0.254,95% confidence interval 0.068 ~ 0.949,p=0.042),Fisher grade(odds radio=0.18,95% confidence interval 0.038~0.858,p=0.031)and higher blood lactate levels at 3 days after microsurgery(odds radio=3.184,95% confidence interval 1.065 ~ 9.507,p=0.038)was an independent predictive maker of poor outcome.Conclusions: 1.The arterial blood lactate levels in patients with a SAH were higher than the standard control;increased lactate levels reached maximum levels on admission and then decreased,the levels slightly increased again on the first day after surgery.2.In a SAH,dynamic blood lactate measurements may has a predictive role for outcome and represent a marker of disease severity;the lactate level at 3 days after microsurgery was an independently factor for prognosis.3.The arterial blood lactate levels in patients with a SAH were highly associated with Hunt-Hess grade and Fisher grade,the higher the grading,the higher the arterial blood lactate level. |
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